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									      2011 Lady Tiger Soccer Academy
WHO:                   Camp is open to students entering 1st - 9th grade next year
WHAT:                  Lady Tiger Soccer Academy, directed by Coach Jay Zeller
WHEN:                  Tuesday, June 7th – Friday, June 10th
WHERE:                 Mansfield High School – 3001 E. Broad St. Mansfield, 76063
TIME:                  1st – 6th (8:30 am - 11:30 am) – open to boys and girls
                       7th – 9th (1:00 pm - 4:00 pm) – open to girls only
COST:                  $65 – All campers will receive a camp t-shirt
                       There will be a concession stand with drinks and snacks!

      Fill out the following registration form and mail it to: Jay Zeller,
      Mansfield High School, 3001 E. Broad St., Mansfield, TX 76063.
             Registration deadline preference is Friday, May 27th.
                       Please make checks/money orders payable to Jay Zeller.

                             Contact Jay Zeller at 817-690-2458 with questions
----------------------------------------------------------------------------------------------------------------------------- ----
                       cut out along the line and mail the form and payment to the MHS address above

I ___________________________________________ would like to enter my daughter in the Lady Tiger Camp.
            print parent first and last name

This form is to certify that I, parent or guardian of ______________________________________________, hereby
                                                                            name of participant
grant permission to Lady Tiger Soccer Academy to obtain medical care from any licensed physician, hospital, or
medical clinic for the player named herein if a parent or legal guardian cannot be contacted in person or by telephone.
This authorization shall include all camp activities, and we do hereby waive, release, absolve, indemnify, and agree not
to hold Jay Zeller, Lady Tiger Soccer Academy, the organizers, supervisors, or participants responsible for any claim
arising out of injury to the player or accidents that may occur during the camp.

Parent Signature: _______________________________________________                      Date: _________________________

Parent’s email address: ____________________________________ ______________________________________

Camper’s Name: ___________________________________________ Grade for 2011-2012 School Year: _________

Address _______________________________________ City: __________________________ Zip: ____________

Home Phone: _______________________ work or cell # Mom: ___________________ Dad: __________________

Emergency Contact Person: __________________________________________ Phone: _______________________

Circle T-Shirt size:       Adult: SM           MED   LG     XL        or     Youth: SM        MED      LG

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