Iowa City Alliance

Alliance Strikers Camp Registration Form

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Dates: August 11-14, 9:00 AM - Noon at the Iowa City Kickers Complex

Ages 8-14

Camper First Name
Camper Last Name
Date of Birth
Sex	Male Female
Shirt Size	Chose Size Youth Medium Adult Small (YL) Adult Medium Adult Large
Soccer Club	Chose Club Alliance CRSA Heartland ISC Other

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 Strikers Camp.
I, Parent or Legal Guardian Name  
do hereby release Iowa City Alliance Strikers 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 August 1 - $100
After August 1 - $110

Family Rate (by check only):
Each Additional Child – Subtract $10

To choose Payment Options click the Submit Form button below: