Packer Soccer Camps

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* Indicates Required Field

*Camper First Name:
*Camper Last Name:
*Parent First Name:
*Parent Last Name:
*Home Address:

*Town:
*State:
*Zip Code:
*Home Phone:
Business Phone:
*Cell Phone (in case of emergency):
School:
*Email:
*Sex:	MaleFemale
*Age At Camp:
*Date of Birth:
*Are You A Repeat Camper?:	YesNo
*Doctor Name:
*Doctor Phone:
*Tshirt Size:	ADSMADMEDADLG

Additional Comments:

The following are fees
for Premier Program 2021 for Ages 12 - 14

Half Day
9:00 AM - 12:00 PM
$275 for 1 Week Session

I would like to sign up for the following sessions:

Week

Amount

*	June 21 - June 25, 2021 Mon.-Fri. Half DayNone	$
*	June 28 - July 2, 2021 Mon.-Fri. Half DayNone	$

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.

*Click here to agree to our camp medical release

If you have any questions please email us at or call us at (203) 866-4830

Our Mailing Address is:
Packer Soccer Camps
43 Pine Point Road
Rowayton, CT 06853
(203) 866-4830