Clinic Attendance *

Please select which days you will be attending.

Day 1

Day 2

Parent Name *

First Name

Last Name

Parent Phone *

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Player Name *

First Name

Last Name

Player Birthday *

MM

DD

YYYY

Player Phone

If applicable

(###)

###

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Emergency Contact *

different from above

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Checkbox *

Summit Soccer will be posting soccer/camp related content to our social media pages. Videos and photos will be used to demonstrate technique, skill and positive coaching. Please give your permission to post soccer-related footage of your athlete by checking the box. Please note your athlete's full name will not be used in the post.

Click to give permission