Soccer Camp Registration

CAMPER INFORMATION
all fields must be completed unless otherwise noted

First name:
Middle initial:	(optional)
Last name:
you must use a legal name to avoid creating duplicate records
Date of birth:
Gender:	Male Female Please select a gender
Club/League:
School:
Grade:

CAMP CHOICE(S)
Please note that the prices below are for pre-registered campers. Registering on-site will incur a $10 increase in price.

Phil Scicluna Soccer Camps Please select at least one camp
	President's Day Camp Gilman Turf Fields, Berkeley	February 20th	Monday	9am - 3pm	$50 After-care available upon request.
	Cesar Chavez Day Camp Gilman Turf Fields, Berkeley	March 30th	Friday	9am - 3pm	$50 After-care available upon request.
	Spring Break Camp Gilman Turf Fields, Berkeley	April 2 - 6	Monday - Friday	9am - 3pm	$200 After-care available upon request.
	Spring Break Camp Gilman Turf Fields, Berkeley	April 9 - 13	Monday - Friday	9am - 3pm	$200 After-care available upon request.
	Goal Mexico Trip - Chaperone San Francisco, Mexico	July 7 - 14	Saturday - Saturday	Full days/nights	TBD Accepting Reservations for 2012.
	Goal Mexico Trip Stay witha Mexican Family	July 7 - 14	Saturday - Saturday	Full days/nights	TBD Accepting Reservations for 2012.
Past Camps
	U16 Girls Sirens Team Camp Location TBD	August 1 - 5	Monday - Friday	4pm - 7pm	Price based on number of participants
	Summer Camp Oceanview, Albany	August 8 - 12	Monday - Friday	9am - 3pm	$245
	Half Day Summer Camp Oceanview, Albany	August 8 - 12	Monday - Friday	9am - 12pm	$160
	U11 Boys ABSC United Team Camp Oceanview, Albany	August 8 - 12	Monday - Friday	9am - 3pm	Price based on number of participants After-care available upon request.
	U12 Girls Waza Team Camp Berkeley/Albany Area	August 8 - 12	Monday - Friday	9am - 3pm	Price based on number of participants After-care available upon request.
	All-Ages Girls Camp Memorial Field, Albany	August 15 - 19	Monday - Friday	9am - 3pm	$245
	U12 Girls Waza Team Camp Berkeley/Albany Area	August 15 - 19	Monday - Friday	9am - 3pm	Price based on number of participants After-care available upon request.
	U8 - U12 Boys Camp Fielding East, Berkeley	August 15 - 19	Monday - Friday	4:30pm - 7:30pm	$150
	U15 Boys ABSC Gladiators Team Camp Memorial Field	August 15 - 19	Monday - Friday	9am - 3pm	Price based on number of participants
	U15 Boys ABSC Vikings Team Camp Memorial Field	August 15 - 19	Monday - Friday	9am - 3pm	Price based on number of participants
	Beach Camp GG Park + Ocean Beach	August 22 - 26	Monday - Friday	9am - 3pm	$275
	Half Day Beach Camp GG Park + Ocean Beach	August 22 - 26	Monday - Friday	1pm - 3pm	$35/day
	U14 Girls ABSC Berkeley United Team Camp Fielding West	August 22 - 26	Monday - Friday	9am - 3pm	Price based on number of participants
	All Ages Day Camp Coaches Field, 898 Red Rock Rd, Piedmont	November 7	Monday	9am - 3pm	$40 per person
	All Ages Day Camp Hampton Field, Oakland	November 11	Friday	9am - 3pm	$40 per person
	All Ages Day Camp Raymond Kimbell Playground	November 11	Friday	9am - 3pm	$50 per person

COMMENTS

GUARDIAN & EMERGENCY INFORMATION
all fields must be completed unless otherwise noted

GUARDIAN INFORMATION
First name:
Last name:
Address:
City:
State:
Phone:
Email:
	Email must be vaild in order to receive your confirmation!

EMERGENCY INFORMATION
Contact #1:
Primary phone:
2nd phone:	(optional)

Contact #2 :	(optional)
Cell phone:	(optional)
Work phone:	(optional)

I hereby authorize the staff of Phil Scicluna Soccer Camps to act for me according to their best judgement in any emergency requiring medical attention, and I hereby release the camp from any and all liability for any physical injuries or illness that may occur to the above named camper at camp. I have no knowledge of any physical impairment that would be affected by the above named campers participation in the camp program as outlined above. My submission of this online form also states that the above named camper is covered by my personal medical insurance policy. I understand that Phil Scicluna Soccer Camps reserves the right to cancel any camp due to low enrollment or unforseen schedule changes.

Waiver
Be sure to print, fill out and include the appropriate waiver with your check:

Camp Waiver (749k PDF)

Payment
Mail to P.O. Box 330180, San Francisco, CA 94133.

Make Phil Scicluna Soccer Camps check payable to "Phil Scicluna Soccer Camps"

Questions? 415.342.5851 or sciclunacamp@yahoo.com.