Application

2010 Joe Clarke Soccer Camps
One Brookings Drive, Campus box 1067

St Louis, MO  63130

PERSONAL INFORMATION
Name Male Female
Address
City State Zip
Birthdate Age at camp Grade next fall
E-mail
Father Mother
Telephone (Home) (Home)
  (Work) (Work)
  (Cell) (Cell)
Roommate or friend preference for day camp   1)
2) 3)
Former Camper? Yes No If yes, what year

June Day Camp

(for male and female age 6-14) (challenge program for experienced soccer players)
Week One   June 7 - 11 at Washington University.
Week two    June 14 - 18  at Chaminade HS
Please pick mini or full day.  Those 9 or older indicate if you are signing for the challenge program.
Mini: 9 AM to Noon - $125 Full: 9 AM to 4 PM - $235
Registrant is age 9 or more and is registering for the CHALLENGE PROGRAM.
                                           
Showcase Residential Camps at Washington University
High School Boys (as of Fall 10)
Residential Showcase Camp   June 19 - 23        July 17 - 21 resident $520 commuter $420

I am registering for the specialized goal keeper training at the residential camp

I am a rising senior; requesting an admissions interview while attending the residential camp

July Specialty Camps at Washington University (9 AM to 12:15) (boys and girls age 9 - 18)
Youth Skills and Games July 6 - July 9 $110
Goal Scoring July 6 - July 9 $110
Goal Keeping at Goal Scoring July 6 - July 9 $110
Dribbling Wed., July 14 - Fri., July 16 $85
   
   
   
OTHER DETAILS
Please indicate your soccer ball choice
I will purchase the camp soccer ball - $20
I will bring my own ball (marked with my name and phone number on it)

Special Note: Team (i.e. ten or more from the same team submitting their applications and deposits together by June 1) or Family (more than one from the same family registering for any of the 2009 camps) Such registrants will receive a FREE CAMP SOCCER BALL.
 I am participating in the camp with my team or other family members

Questions; call 314-935-5174

You will need to print and fax or mail in the form.  Then hit back button and Pay on line via PayPal.

Link to Medical Form and Release

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