Juniors: Soccer Camp • Miftaah Institute
Juniors: Soccer Camp
$100
Parent's Name
Parent's Phone Number
Parent's Name (2)
Parent's Phone Number (2)
Email address
Address
City
State
Postal Code
Student Name
Student Gender
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Male
Female
Age
Grade
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Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
Does your child have any disabilities, learning needs, behavioral challenges, or anything else you'd like us to be aware of to better support them?
Does your child have any allergies (food, medication, environmental, etc.) that we should be aware of?
Select an option
No
Yes
I understand attendance is expected weekly
I understand orientation is mandatory for soccer
Previous soccer experience:
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Beginner
Intermediate
Advanced /Club Level
Jersey Size
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Youth S
M
L
XL
Adult S
Permission to use photos/videos of student for:
Permission to use photos/videos of student for:
Marketing / website / social media
Internal use only
No media use
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$100
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