Lawrenceville School, New Jersey First Name*Player's First name Last Name*Player's First namePlayer's Age*On 6/1/2021 Address*Mailing AddressCity*Your CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificSelect Your StateZip Code*Mailing ZipPrimary Contact*First Name Primary Contact*Last NameParents Email*Best email AdressParents Cell*Primary ContactOther CellEmergency ContactProgramSelect ProgramPlease Select Your ProgramSmart Soccer Program 7 + 8 year oldsJunior Soccer Academy Program 9 + 10 year oldsJunior Soccer Academy Program 11 + 12 year oldsElite Soccer Academy Program 13+14 year oldsElite Soccer Academy Program 15-18 year oldsAdvanced Academy Program 12-18 years oldCollege ID Camp - 14-18 years oldGoalkeeper ProgramCamp Level and AgeGoalkeeper Yes I want the Goalkeeper Program Check for yesVenue and Camp DatesLawrenceville School NJJuly18-22 Lawrenceville SchoolJuly 25-29 Lawrenceville SchoolAugust 1-5 Lawrenceville SchoolJuly 18-22, 25-29 Aug. 1-5Mujica Family 7/25-29, 8/1-5Camp & PricingCamp & PricingResidential CampDay CampTeam CampsSelect Camp*$625.00 Residential Camp$425.00 Day Camp$150.00 Day Camp Deposit$225 PIF 1/2 Day CampMujica Family Discount 2 weeks at $182 each = $364Uniform Size*Youth SizesX-SmallSmallMediumAdult SizesLargeX-LargeXX-LargePlayer InfoLast Team PlayedTeam Name & CityHow did you find us?Friend, Search, PlayerRoommateName of requestedDo you agree?My child is in good health and has my permission to participate in all camp activities. In case of emergency, I hereby give my permission to the Doctor, selected by the Director of Europa Soccer Camp, to secure proper treatment. All pictures and videos may be used by Europa Soccer Camps at their discretion.YesNoNo refunds, only a transferable credit towards a future camp at any of our locations.Total $0.00 This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name
