OSYSA FUNdamentals Registration Form

FUNdamentals Camp
Registration Form
For Younger Players

Fill out Registration form below and press "Submit"

Camp Selection and General Information

Camp Dates/Time You Would Like to Attend:

Player's Name:

First:

Last:

Player's Gender:

Boy Girl

Field Players Only:

Field Player

Would you also like to register a Sibling for this camp for a 10% discount?

Yes No

Sibling's Name:

(Sibling must complete a separate registration form)

Email Address:

Date of Birth

(ex: mm/dd/yyyy)

Address:

City, State:

Zip:

Home Phone:

(ex: 555-555-5555)

Work Phone:

OSYSA/adidas Camp Store
(If you wish to purchase an adidas Camp Ball or T-shirt)

Ball and Camp Shirt ($20.00):

Camp Ball Only ($15.00):

Camp Shirt Only ($10.00):

T-Shirt Size:

YS YM YL
AS AM AL

Ball Size Request :

3 4 5

Medical Release

I/we hereby agree that the local organizing soccer group and the OSYSA Soccer Clinic shall not be liable for any injury or loss which my child(ren) may sustain while participating in this soccer clinic, and I agree to indemnify and to hold harmless the organizing soccer group and/or the OSYSA Soccer Clinic from any claim whatsoever.

Agree to Release Terms Above:

Yes

Known Medical Problems/Allergies:

Emergency/Cell Phone #:

Credit Card Information

Payment Option:

Pay in Full Pay $25 Deposit

Total Amount to be Charged:

Cardholder Name:

Credit Card Number:

Expiration Date:

Cardholder Address:

Cardholder Zip:

I/we (above indicated) hereby acknowledge that I/we have reviewed this form and caused it to be electronically executed with the intent to be bound to the terms/pricing, including the Camp Refund Policy, contained herein*.

Please click ONLY ONCE on the Submit button above.
Sometimes, it takes a few seconds for the form to be processed. Thank you.

Camp Sponsors:

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OSYSA uses
Secure Socket
Layer (SSL)
technology
to send your
payment information
to our server.

OSYSA Accepts
these Credit Cards: