*Camper First Name:
*Camper Last Name:
*Parent First Name:
*Parent Last Name:
*Home Address:
*Town:
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*Zip Code:
*Home Phone:
Business Phone:
*Cell Phone (in case of emergency):
School:
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*Sex:	MaleFemale
*Age At Camp:
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*Are You A Repeat Camper?:	YesNo
*Doctor Name:
*Doctor Phone:
*Tshirt Size:	YSMYMEDYLYXLADSM

Additional Comments:

The following are fees for Grasshoppers Program 2022 for Ages 3 - 4 Half Day 10:00 - 11:00 AM $150 for Week 1 / $150 for Week 2 I would like to sign up for the following sessions: Week Amount * June 20 - 24, 2022 Mon.-Fri. Half Day None $ * June 27 - July 1, 2022 Mon.-Fri. Half Day None $ TOTAL $

Proceeds from the Rowayton Camp will be donated to Haiti Lumiere de Demain, a non-profit organization which promotes literacy among the children of Haiti.

Medical Release

I enroll my child to participate in any and all activities of the Packer Soccer Camps, Inc., and I waive all claims against the camp owners,organizers, sponsors, supervisors, coaches, related personnel and employees which might arise as a result of injuries in approved camp activities. I verify that my child has his/her own medical insurance policy, and I have made all arrangements to determine his/her physical fitness to attend camp. I hereby give consent for my child to be medically treated for injuries or illness during his/her participation in camp.

INFORMED CONSENT: COVID-19 is a serious and highly communicable disease. An inherent risk of exposure to COVID-19 exists in any public place where people are present. Although Packer Soccer Camps, Inc. asks all attendees, guests, parents and staff to observe precautions, there is no assurance of protection from exposure to COVID-19 at our camp. The risk of exposure to COVID-19 is voluntarily assumed by all attendees.

*Click here to agree to our camp medical release