Untitled Document
 
 Online Application

Please complete the following online application & consent form.  If you would prefer to print and mail in your application & consent form please click below to download a PDF version:

TO PRINT OFF APPLICATION AND SEND IN Click here for PDF - Camp Application & Consent Form

 

TO APPLY ONLINE AND MAIL CHECK FOR FEES & CONFIRMATION,

SEE BELOW:
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Please complete the following Application & Parental Consent form.

APPLICATION
 
Name*
Address*
City / State / Zip*
Home Phone*
Email (for confirmation)*
Age*
Sex*
Grade (Fall 2008)*
Parents
Friends (LIST ROOMMATES IF APPLICABLE) I would like to be grouped with:

 
Creighton Soccer Camps and Creighton University cannot be responsible for injuries sustained at camp. All campers must carry their own insurance. Please complete the Parental Consent Form before mailing application! The Parental Consent Form must be complete in order to attend camp.
 
CHECK THE APPROPRIATE BOXES:

Little Jays Day Camp - Boys & Girls ages 4-5
(no early discount!)

  

Junior Jays Camps - Boys & Girls Ages 6-12  ($125)
($25 Discount if registered by April 1, 2007)



  

Girls Academy (Overnight or Commuter) CampAges 9-18


Please Select:
  

Girls Goalkeeping & Goalscoring Academy (Overnight or Commuter) Camp Ages 9-18


Please Select:

($200 Deposit required before June 1st)
  
  

DISCOUNT
Registrations postmarked by April 1 will receive a $25 discount (ECXLUDES LITTLE JAYS).



 
PARENTAL CONSENT
 
Name of Camper
Date of Birth
 
Please provide the following information about the above minor:
 
Alergic Reactions
Present Medications
Date of last Tetanus Toxoid
Past illness or other information that would be useful in the event of treatment if necessary:
 
IN CASE OF AN EMERGENCY:
 
Father
Home Phone
Work Phone
Cell Phone
Mother
Home Phone
Work Phone
Cell Phone
  
Insurance Company
Policy Holder
Policy Number

  
 
I hereby certify that the Creighton Soccer Community Camp staff has full and unconditional authority to proceed with diagnosis and treatment as judgement indicates for injuries during camp. The Creighton Soccer Community Camp and Creighton University shall not be held responsible for any consequence resulting from such injuries.

I declare that I am the father/mother/guardian of the above-named minor.

 
This form must be completed prior to registration to allow camp participation.
 

Send Application / Camp Fees to:
Bruce Erickson's Creighton Soccer Camps
2500 California Plaza
Omaha, NE  68178
*Required
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