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Elite 5-Day College Prep Camp Registration for the Commuter

June12th-17th

This Camp is no longer accepting Registrations. Please continue to check back with the website for future camps!

Player's First Name

Player's Last Name

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Birthday

Primary Position

Player's Club Team

Thanks for Registering for College Prep Soccer Academy Camp!

Does the player have any dietary restrictions or food allergies? If so, please list everything we need to know.

Does the player have any medical conditions or injuries we should be aware of? Please include concussion history. Also include any current medications the player is taking.

Parent/Legal Guardian Name

Parent/Legal Guardian Email

Parent/Legal Guardian Phone

Parent/Legal Guardian Work Phone

Insurance Carrier

Emergency Contact Name

Policy Number

Emergency Contact Phone

I have read and agree to the terms & conditions of the College Prep Soccer Academy Medical Release and Waiver. Checking this box is my electronic signature and consent.View the agreement

COLLEGE PREP SOCCER ACADEMY

Elite 5-Day College Prep Camp Registration for the Commuter

June12th-17th

Camps located at:

Westmont College
955 La Paz Rd.
Santa Barbara, CA. 93108

Contact us at: admin@collegeprepsocceracademy.com