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Please Print and Send
to:
Cobber Soccer Camp, Concordia
College, 901 South Eighth St., Moorhead, MN 56562
PLEASE PRINT CLEARLY
Name: ________________________________________________________________
Address: ______________________________________________________________
City: _____________________________________ State: ______________________
Date of Birth: _________________ Age: __________ Grade in School: ____________
Email: ______________________________________________
Parent/Guardian: _______________________________________________________
Home Phone: _________________________________________
T-shirt Size (specify youth or adult): ________________________________________
In the 2005 Soccer Camp the
dates set forth in this application, and in consideration of your acceptance
of the application, we (I) hereby release
Cobber Soccer Camp Staff
and Concordia College and all their employees and agents from all claims
on account of any injuries which may be
sustained by our (my) son
or daughter while attending the camp, and any claims which hereafter may
be presented by our (my) minor son or daughter
as a result of any injuries.
I also certify he/she is medically fit to participate in this camp.
DATE: _________________ SIGNED: ________________________________________
Camp Session(s):
Please check the camp(s)
you are entering.
______ July 11th-July 15th: 9-11:30 AM (ages 8-12) $85
______ July 11th-July 15th: 1-5:00 PM (ages 13-18) $100
Please check one:
_____ I will be purchasing
a Cobber camp ball
(enclose $20 payment with
application -- include ball size)
_____ I will bring my own soccer ball
Please check one:
_____ Forward
_____ Midfielder _____ Defender _____ Goalie
A non-refundable fee
of $40 is required to hold your spot in this camp. The balance is
due at registration. Please make checks payable to: Cobber Soccer Camps
Send to: Cobber Soccer Camps,
Concordia College, 901 South Eighth St., Moorhead, MN 56562
Camp Director - Dan
Weiler
Call 701-361-8625 or email:
weiler@cord.edu
This page is maintained
by the Concordia Sports Information Office sid@cord.edu