Boys and Girls Future Olympian (Youth) Soccer Academy Registration

Registrations received after August 2nd are $59. Scholarship opportunities may be available upon written request. Registration includes camp T-shirt and Soccer Ball; register ASAP toensure size of shirt. Shirt size availability is not guaranteed if payment is not received prior to August 2nd.

Itens needed: Soccer gear and water.

Please fill out all fields below and accept the terms. After submitting, you will be taken to PayPal for secure payment.

Player

Players Name

Players Birthdate (mm/dd/yy)

Players Grade Entering

Players Address

City, St, & Zip

Players Email (optional)

Select T-Shirt Size:

Referred To Camp By:

Parent/Guardian

Parent/Guardian Name

Parent Address

City, St, & Zip

Home Phone

Cell Phone

Parent Email (required)


Emergency Contact

Emergency Contact Name

Contact Address

City, St, & Zip

Emergency Contact Phone

Alternate Phone


Medical Information

Physician Name

Physician Phone

Insurance Company

Policy Number

List any special medical conditions or allergies:

Medical Authorization Release:
I hereby authorize any emergency treatment for any condition occurring at camp that requires medical attention. I have no knowledge of any impairment, (other than indicated below) that would be affected by my child’s participation in camp activities. I will be responsible for the cost of any medical treatment or other charges incurred in connection with my child’s attendance at the camp. In consideration of my child being permitted to participate in camp, I hereby release the camp, and it’s agents, from any and all liability to me and my child for any and all loss or damage on account of injury to my child sustained while participating in soccer camp. I agree to assume full responsibility for the risk of injury to my child occurring during participation in soccer camp. This release is intended to be as broad and inclusive as permitted by the laws of the State of Oregon. Any photos of videos taken during the sessions of the participants may be used at the discretion of the Sprague Olympian Soccer Camp / Program.

Check Here if You Accept The Above Terms And Conditions

All payments are processed by Pay Pal. You will be taken to a secure Pay Pal page after you click the button. If you would prefer, after you click the button you can mail your payment by check made payable to "Oly Soccer" to:

Sprague Soccer
2373 Kuebler Rd S.
Salem, OR 97302