COCALICO SOCCER SCHOOLS

Circle one: Cocalico Soccer School (entering gr. 3-9) June 16-20, 9 am-12:00 pm

Little Eagles Soccer School (entering gr. 1-2) June 16-19, 6:30pm – 8 pm

Name: _________________________________________________________

Parent’s Names: _________________________________________________

Address: __________________________ Town: ___________________ Zip: ________

Home Phone #: _________________ Height: ______Weight: _____ Age: ____ Sex: ___

Emergency Contact Person: __________________ Emergency Phone #: _____________

Health Insurance Company: __________________ School Attended: ________________

Grade (next year): ____ List any Medical Problems: _____________________________

E-mail Address ___________________________________________________________

Camp Ball (Purchase Not Required $15 per ball)

Size 3 (grades 1 and 2) ____ Size 4 (under 11 years old)____ Size 5 (11 and over)____

Please print and complete all information. Send Payment (payable to Cocalico Soccer School) and Application to:

Cocalico Soccer School
C/O Dan Hogan
P.O. Box 800
Denver, PA 17517
daniel_hogan@cocalico.k12.pa.us  or call (717) 201-3805

Before May 15th, Cocalico Soccer School (entering grades 3 - 9) ------$65
Little Eagles Soccer School (entering gr. 1 & 2) ----------------------------$40
After May 15^th, Cocalico Soccer School ---------------------------------------$75
Little Eagles Soccer School -------------------------------------------------------$50

DISCOUNT INFO: If you have more than one child attending either camp AND pay before May 15^th, subtract $10 per camper. No discounts apply after May 15^th.

AGREEMENT: All Participants and their parents or legal guardians agree that the Cocalico Soccer School will be held harmless against any liability. Camp staff will provide responsibility, cleanliness and order during the program. Any and all damages/injuries become the financial responsibility of the participant.