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Port City Soccer SUMMER Camp Registration
Please check correct age group:
FUNdamental's Camps in Wilmington! 50.00 and includes a t-shirt!
Rising U4 - U5's (born in 2013 or 2014) June 5 - 8th 5:15 - 6:00 pm
Rising U6 - U7's (born in 2011 or 2012) June 5 - 8th 6:15 - 7:00 pm
Rising U4 - U5's (born in 2013 or 2014) June 19 - 22nd 5:15 - 6:00 pm
Rising U6 - U7's (born in 2011 or 2012) June 19 - 22nd 6:15 - 7:00 pm
Striker Camps in Wilmington! 75.00 and includes a t-shirt!
Rising U9 - U12's (born in 2006-2009) June 12 - 15th 6:00 - 7:30 pm
Rising U9 - U12's (born in 2006-2009) June 26 - 29th 6:00 - 7:30 pm
Introduction to 7 v 7 Camp! 75.00 and includes a t-shirt!
Current U7's / Rising U8's (born in 2010) July 24 - 27th, 6:00 - 7:30 pm
Player Information:
First Name
*
Last Name
*
Street Address
*
City
*
State
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North Carolina
Other
Zip Code
*
Date of Birth
*
Gender
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Male
Female
T-shirt Size:
*
YXS
YS
YM
YL
AS
AM
AL
Please list any medical concerns (including contact lenses):
FAMILY INFORMATION
Please provide e-mail for game cancellations, schedule changes, updates:
*
Receive Mass Email?
You will receive e-mail updates on field closings and camp cancellations. This is our main way of contacting you on short notice!
Mother's Name
*
Best number to reach Mom:
*
Father's Name
*
Best number to reach Dad:
*
Emergency Contact name (other than parent):
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Emergency Contact phone number (other than parent):
*
ADDITIONAL INFORMATION
Are you playing for Port City Soccer now - Spring 2017?
*
Yes
No
If no, where do you play?
WE ARE A GREAT COMMUNITY VOLUNTEER ORGANIZATION - PLEASE HELP OUT WHENEVER & WHEREVER YOU CAN !
I am interested in Port City Soccer sponsorship opportunities:
yes
no
Sponsor name:
Sponsor contact:
Sponsor phone:
DISCLAIMER - Initials Required!
I, AS A PARENT OR GUARDIAN OF THE ABOVE NAMED PLAYER/PARTICIPANT, DO HEREBY GIVE MY APPROVAL TO MY CHILD’S PARTICIPATION IN ANY AND ALL ACTIVITIES OFFERED BY THE WILMINGTON SOCCER ACADEMY (WSA), AND PORT CITY SOCCER (PCS) . I ASSUME ALL RESPONSIBILITY FOR HAZARDS INCURRED IN THE CONDUCT OF ACTIVITIES, AND ALSO THE TRANSPORTATION TO AND FROM ACTIVITIES, AND I DO FURTHER RELEASE, ABSOLVE, INDEMNIFY, AND HOLD HARMLESS THE PCSC, US CLUB SOCCER, THE UNITED STATES SOCCER FEDERATION AND ALL OTHERS LISTED HEREAFTER: ORGANIZERS, EMPLOYEES, OFFICERS, BOARD MEMBERS, COACHES, REFEREES, SPONSORS, SUPERVISORS, AND LANDOWNERS PERMITTING USE OF THEIR LAND FOR SOCCER ACTIVITIES, ANY AND ALL OF THEM. I FURTHER AGREE TO ABIDE BY ALL THE RULES, REGULATIONS, AND DECISIONS OF PCS AND AGREE TO ACCEPT ANY DISCIPLINARY ACTION TAKEN BY PCS’S BOARDS, OFFICERS, OR REFEREES. I UNDERSTAND THAT MY CHILD’S PHOTOGRAPH MAY BE TAKEN DURING EVENTS AND GAMES BY PCS PHOTOGRAPHERS AND MAY BE PUBLISHED THROUGH VARIOUS PCS AFFILIATED MEDIAS INCLUDING, BUT NOT LIMITED TO, THE PCS WEBSITE, CLUB NEWSLETTERS, AND PCS BROCHURES. IN CASE OF ANY INJURY TO MY CHILD, I WAIVE ALL CLAIMS AGAINST THE PCS, ORGANIZERS, SANCTIONING BODIES, COACHES, SPONSORS, W.S.A., LANDOWNERS OR ANY OF THE SUPERVISORS APPOINTED BY THE PCS. BY INITIALING BELOW, I AGREE WITH THE ABOVE DISCLAIMER.
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FEE SECTION AND LOCATION OPTIONS:
2017 FUNdamental Camp Sessions (includes a t-shirt)
50.00
2017 Striker or 7 v 7 Intro Sessions (includes a t-shirt!)
75.00
I understand that by registering online and not making payment at this time that my child's registration will be void and space will not be held for him/her.
*
Yes
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