Monroe, UT – Registration Summer 2019

To register and pay via PayPal please fill out the form below.

For questions please contact Byron Peterson (435) 558 0359 or email bpeterson@me.com

Download Monroe UT – Summer 2019 Registration (for check payment)

If players want to pay by check it’s payable to: Callaghan’s English Soccer Camps. Mail to: Attn Byron Peterson, 1548 W 900 N, Monroe, UT 84754

Registration Form

Please fill in the  information and click submit to pay and reserve placement on the camp.

Venue, Date, Time

Mountain View Park, 220 S 300 W, Monroe, UT 84754

All players aged 6-18 (Players will be grouped according to age)

Date: June 24th-28th 2019 *

5pm-8pm

Player

First Name *

Last Name *

Gender *

M

F

DoB *

Address and Phone Numbers

Street Address *

City *

State *

Zip *

Phone Number *

Email Address *

Emergency Phone Number *

Name of Physician

Phone Number

Name of Parent/Guardian *

Phone Number *

Bring: Water, Ball, Shin guards, sunscreen

Cost: $125 before May 1st ($140 after May 1st)

Contact: Byron Peterson (435) 558 0359 or email bpeterson@me.com

Waiver

I hereby release Callaghan’s English Soccer Camps, all it’s staff and all affiliated groups from any responsibility for any injury sustained by my son(s) or daughter(s) during participation in or travel to or from this soccer camp. I will not hold same responsible for medical payments for accidents or injuries sustained. I also grant permission for emergency medical treatment to be administered if deemed necessary by C.E.S.C. or emergency services staff.

Please check: *

I acknowledge that I have read and agree to the above waiver

Photography Release

I hereby grant Ed Callaghan the irrevocable and unrestricted right to use and publish for marketing and advertising purposes and in any medium, including website and internet promotion, all photographic and digital images of my child.

Section

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