Camper Information | JDS

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Camper Information

Camper First name

Camper Last Name

Gender

Camper Age

Rate your camper's soccer level

What is your YOUTH T-Shirt Size?

Parent - Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone

Email

Emergency Contact Information

Primary Emergency Contant Name

Primary Emergency Contact Phone

Seconday Emergency Contant Name

Secondary Emergency Contact Phone

Are there any medical concerns you feel we should know about your camper (i.e allergic to bee stings, food allergies, asthma carries inhaler, epipen etc... explain below)

Select an option *

Yes

No

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