Registration Form Click here to download the printable registration form. PLAYER INFORMATION * Applicant's Full Name * E-mail Address: * Age * Sex Male Female * Address * City * State * Zip Code PARENT/GUARDIAN INFORMATION * Parent/Guardian's Full Name * Home Phone * Work Phone * Mobile Phone * Email Address CAMPS AND PROGRAM INFORMATION * Summer Camps N/A Summer Camp - day camp June 22nd - June 26th (9am - 3 pm) Summer Camp - mini camp June 22nd - June 26th (5pm - 8pm) Summer Camp - day camp July 6th - July 10th (9am - 3pm) Elite Camp July 27th - July 31st (9am - 3pm) Galaxy Camp Aug. 3rd - Aug. 7th (9am - 3pm) Wildcats Camp Aug. 10th - Aug. 14th (9am - 3pm) Wildcats Mini Camp Aug. 10th - Aug. 14th (5pm - 8pm) Mini Camps Aug. 17th - Aug. 21st (9am - 12pm) Lions- BSC & FC Rockville Aug. 17th - Aug. 21st (5pm - 8pm) Residential Camp - coming soon * Training Programs N/A Individual Training - 10 sessions minimum - 1 hr/week ** $70/hour Goalie Training - 10 sessions minimum - 1 hr/week ** $70/ hour Group Training - 10 players minimum ** $60/ player Player Evaluations - 1 game or 1 training ** $150/ player Speed Training - 6 weeks ** $190/ person Tots Program - 6 weeks - 1 hr/ week ** $110/ player Tots Program - 8 weeks - 1hr/week ** $125/ player Winter Indoor Tots Program - 6 weeks, 1 hr/ week ** $120 Winter Skill Clinic - 8 weeks minimum, 90 min ** $250/ player * Program Dates * Team Programs N/A Team Consulting - Call for details Team Evaluations - 1 session (game or practice) ** $175 Team Training - 12 sessions - 90 min/ week ** $175 training * Team Name * Total Cost PAYMENT INFORMATION Make check payable to Emile Mbouh and bring it to the first session or mail to: Emile Star Soccer 451 Hungerford Drive Suite 119 - 318 Rockville, MD 20850 All payments are nonrefundable after the starting date. A $45 application fee will be charged in case of cancellation before the starting date. PLAYER MEDICAL INFORMATION & WAIVER * Does your child have any allergies or medical conditions that we should know about? Liability Waiver As a participant in a program run by Emile Star Soccer, my son/daughter is in good health and has my permission to participate in the soccer program. emile star soccer, and its directors, employees and the facilities assume no responsibility and will not be held liable for any injuries and illness, accident will at the camp resulting in medical, dental or other expenses. I also give Emile Star Soccer permission to use my child’s name and or picture in promotion of the camp/program in printed media and another forms of advertisement. I fully renounce all claims upon emile star soccer for reimbursement for the use of this material. * I agree. Enter Name or Parent/Guardian & Date Here * Required Field
PLAYER INFORMATION
PARENT/GUARDIAN INFORMATION
CAMPS AND PROGRAM INFORMATION
PAYMENT INFORMATION
Make check payable to Emile Mbouh and bring it to the first session or mail to:
Emile Star Soccer 451 Hungerford Drive Suite 119 - 318 Rockville, MD 20850
All payments are nonrefundable after the starting date. A $45 application fee will be charged in case of cancellation before the starting date.
PLAYER MEDICAL INFORMATION & WAIVER
Liability Waiver As a participant in a program run by Emile Star Soccer, my son/daughter is in good health and has my permission to participate in the soccer program. emile star soccer, and its directors, employees and the facilities assume no responsibility and will not be held liable for any injuries and illness, accident will at the camp resulting in medical, dental or other expenses. I also give Emile Star Soccer permission to use my child’s name and or picture in promotion of the camp/program in printed media and another forms of advertisement. I fully renounce all claims upon emile star soccer for reimbursement for the use of this material.
* I agree.
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