Child’s First Name    Last Name
Birth Date    Gender
Address
City    State    Zip
Telephone
Email
Parent’s First Name    Last Name
Emergency Phone
Daytime Phone

The Fee for the camp is $110, which includes a T-Shirt.
Full payment is necessary to register online.

Which Session do you wish to attend?
 July 14-18   August 11-15

T-Shirt Size?
 S M L XL

What size ball do you need? (additional $15)
 4 5 Don't know

Please Note: After submitting this application the KSA Staff must process your information before the child is enrolled in camp. You will receive an e-mail from us letting you know that we received your application. Actual written confirmation will arrive in the mail to the address you submitted above which will include a confirmation letter, a map to Parker School, and a medical form.

REFUND POLICY
Cancellations made up to 20 days prior to start of camp are subject to a $50 nonrefundable administrative fee. Cancellations made less than 20 days prior to start of camp are subject to forfeiture of 50% of full camp fee. Monies withheld as a result of cancellation may be applied toward tuition for the following year for the same camper or member of that camper's immediate family. This credit may be used for KSA Camps only. Please feel free to call us at (860-306-5698) if you have any questions or email (coachk@coachksoccer.com)

AGREEMENT OF TERMS
By sending my payment, I hereby authorize the staff at KSA to act for me according to their best judgment in any emergency requiring medical attention, and I hereby waive and release the Camp and its staff from any and all liability for any injuries incurred while at the Camp. I understand that participation in soccer and all other camp activities in a unique camp environment carries with it risk of injury. All medical expenses incurred will be responsibility of the camper or the camper's family. The Camp is not responsible for personal items that are lost, stolen or damaged, I understand the Camp retains the right to use any photograph, videotapes, motion picture recording or any other record of the event for publicity, advertising or any legitimate purpose. I understand and accept the KSA payment and refund policy. By clicking the submit button you are agreeing to the terms set above.