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Summer Camp 4

Monday, August 28th – Friday, September 1st (9:30am – 12:00pm)

Please complete this registration form in full. All fields marked with * are required.

Interest in the Full-Time Program

Please consider this player for the Full-Time Program*

Team Registration
If you are registering with your team and/or qualify for a team discount please indicate the age level and name of your team.

Age Level:

Team Name

Note: Team discounts must be confirmed with us before you qualify for the discount.

Player Information

Name*

First

Last

Date of Birth*

day

month

year

Gender*

Address*

Street Address City State / Province / Region Postal / Zip Code

Player's Phone Number (If none, please input the best phone number to reach the player at for schedule updates, training cancellations, etc...)

Email (Please note that this will be where your registration and other communications will be sent to)*

Please add me to your email list:*

Parent/Guardian Information

Name of Parent 1*

Cell Phone Number - Parent 1*

Name of Parent 2

Cell Phone Number - Parent 2

Please make out tax receipt to:*

Please email the tax receipt to*

Additional Information

Special Instructions/Medical Instructions

What club do you currently play for?

Have you received special soccer training in the past?*

If Yes, with which organization?

Please take a moment to let us know where you heard about us so we can find out where our marketing efforts are most effective

If Other, please indicate name of tournament, website, coach/club, or player where you heard about us.

Liability Waiver

By indicating your acceptance you acknowledge the above-named registrant and the parents/guardians hereby agree that the European Soccer School of Excellence will not be held responsible for any accident or loss no matter how it is caused, and agree to release all instructors, staff or sponsors from all claims or damages which may arise as a result of/or by reason of such accident or loss.*

I agree with the above statement

Image Rights Waiver

By indicating your acceptance you understand and agree that the Roman Tulis staff may take photographic or video images of the above-named registrant. You further grant the Roman Tulis School the right to use such image or likeness in all forms and media, in connection with promotion of our program, or the sport of soccer generally.*

I agree with the above statement

I do not agree with the above statement

IMPORTANT: Before submitting this form, please verify that all information provided is correct and up-to-date.*

I confirm that all entries on this form are correct

Full Time Program

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Summer Camp 4

Monday, August 28th – Friday, September 1st (9:30am – 12:00pm)

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