Iowa City Alliance

Alliance Camp Registration Form

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Program Brochure

Dates: June 16-20

Half Day Option:
9am to Noon (ages 6-9)
1pm to 4pm (ages 10-16)
OR
Full Day Option:
9am-4pm for ages 10-16

Camper First Name
Camper Last Name
Date of Birth
Sex	Male Female
Half or Full Day	Choose Half or Full Day Full Day Half Day
Shirt Size	Chose Size Adult Small Adult Medium Adult Large

Parent Name
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
Work Phone
Cell Phone	for emergencies
E-mail
Emergency Contact
Phone

Special Requests:

In consideration of participation in the 2008 Iowa City Alliance Summer Camp.
I, Parent or Legal Guardian Name  
do hereby release Iowa City Alliance Summer Soccer Camp staff, volunteers, officials and agents from any and all claims, liabilities, loss of service and cause of action of any kind for personal injury and property damage arising in any way out of my child's participation in the camp including accidental injury sustained during the camp and/or any medical problems resulting from involvement in the camp. I also give permission for emergency medical treatment to be administered if necessary in the event that I cannot be reached. Furthermore, I certify that my child is physically fit and able to perform all camp activities. By submitting this form, I hereby acknowledge that I have read the above, I understand it and agree to all the terms.

Do you agree to the above?                                                    No Yes

Fees (PayPal or Check):
Before May 15 - Half Day $89; Full Day $159
After May 15 - $99; Full Day $169

Family Rate (by check only):
Each Additional Child – Subtract $10 for half day and $15 for full day

To choose Payment Options click the Submit Form button below: