Summer Excellence Camp Registration

- Required fields in bold -

Camp Information
Camp Session:	$195: Williamsburg (06/23 - 06/27) $135: Berlin - Youth (08/04 - 08/08) $150: Berlin - HS Preseason (08/04 - 08/08)

Parent/Guardian Information
First Name:
Last Name:
Relationship to Child:
Email:
Phone:
Address:
City:
State:
Zip Code:

Child Information
First Name:
Last Name:
Gender:	Male Female
Birthdate:
Club Team:

Emergency Contact Information
Name:
Phone:
Name:
Phone:
Physician's Name:
Physician's Phone:

Additional Information
Comments:

Send Registration Information