Registration

Please fill out the form below for camp registration. If you prefer to register offline, click here to dowload registration forms.

Camp:

Participation:

Participation days:*

Player Information

First name:*

Last name:*

Birthdate:*

(mm-dd-yyyy)

Gender:*

MaleFemale

Street address:*

City:*

State:*

Zip:*

Parent Information

Parent name:*

Email:*

Home phone:

(555-555-5555)

Cell phone:

(555-555-5555)

Emergency Contact Information

Contact name:

Contact phone:

Doctor's name:

Doctor's phone:

Allergies or other medical problems:

I have read and accepted Consent for Medical Treatment of a Minor.

I have read and accepted Release of Liability.

Registration Policy: Dusko & Juan Premier Soccer, LLC will be glad to apply any unused registration fees to a future program. There is no policy for refunds.