Paul Blodgett Goalkeeper Training School Camp Registration Form

PLEASE SELECT THE CAMP YOU WISH TO ATTEND BY CHECKING OFF FROM THE CHOICES BELOW:

1. ___	Coerver Coaching Day camp at Lawrenceville, NJ:	July 27 - July 31, 2009 9:00am - 3:00pm Cost: $330.00
2. ___	Coerver Coaching Day camp at Hazlet, NJ:	Aug. 3 - Aug. 7, 2009 9:00am - 3:00pm Cost: $330.00
3. ___	College Pre-Season Training Camp - Location: Contact Paul Blodgett	August 2 - August 4, 2009 August 6 - August 7, 2009 ---------------------------------- (Total of 5 days) 5:30pm - 8:30pm Cost: $320.00
4. ___	High School Pre-Season Training Camp - Location: Contact Paul Blodgett	August 10 - August 14, 2009 1:00pm - 4:00pm Cost: $320.00
5. ___	Elite Girl's Soccer Academy at The College of New Jersey	July 19– July 22, 2009 Register at: www.elitegirlssoccer.net

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Camper Name

Date of Birth

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Street

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City

State

Zip Code

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Home Phone

Business Phone (& Ext.)

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Emergency Phone

Cell Phone

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E-mail Address

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Parent's Signature

Date

Enclosed is my check for $__________
*$150.00 down payment is required
**$75.00 is non-refundable for administrative fees

Make check out to: Paul Blodgett

PLEASE FILL OUT THE MEDICAL RELEASE FORM AND SEND IT BACK ALONG WITH THE APPLICATION AND THE PAYMENT. Thank You.