enrollment

							      Chattanooga Player Development Soccer Academy
                     June 18 - 21, 2012
                  Redoubt Soccer Complex

                       Enrollment form

Player Name
                                 6/18-6/21
____________________________     Chattanooga Individual Academy
                                 Full Day 9:00am to 3:00pm ______ $ 150*
Address                          Half Day 9:00am to 12:00pm _____ $ 100
____________________________     6/18-6/21
                                 Chattanooga Team Academy**
City/State/Zip                   6:00 pm to 8:00 pm _____$ 125

____________________________     6/18-6/21
                                 Chattanooga Individual Goalkeeping Academy
                                 Full Day 9:00am to 3:00pm ______ $ 175
Home Phone                       Half Day 9:00am to 12:00pm _____ $ 100
____________________________
                                 6/18-6/21
                                 Chattanooga Advanced Goalkeeping Academy**
Father’s Name                    6:00 pm to 8:00 pm_____ $ 125
___________________________
                                 Please contact John for team rates (10 or more
Mother’s Name                    players)
                                 * $125 for a registered Redoubt player
____________________________     ** Please contact John Millard before registering

Work Phone                       A $50 non-refundable deposit for each camper
                                 must accompany this application
____________________________
                                 Current Level of playing:
Email                            REC. ____ Select/Comp. ____ High School ____
____________________________     Circle T-Shirt size: YS YM YL AS AM AL AXL

Age at Camp                      Circle Ball size:   4   5
__________________________
                                 Mail checks to:     John Millard
                                                     201 Raintree Lane
                                                     Chattanooga, TN 37421

                                 (checks made payable to Chattanooga
                                 Player Development Academy)