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JERSEY SIZE

XS

S

M

L

XL

GLOVE SIZE

6

7

8

                     
                     
                     
Payment Amount:      

Detach enrollment form and mail with fee to:

South Sound Goalkeeper Academy

7844 Diagonal Rd. SE

Olympia, WA 98501

Phone # 360-438-9314

Medical Care Consent

1. I certify that the applicant is physically fit to participate in camp activities.

2. I authorize all medical, surgical and hospital procedures if I cannot be reached in an emergency.

Health Plan:         
Health Plan #: 
                                     
Signature of Parent
                     ________________________
                     
Date:                
                     
                     
                     
 Medication currently taking:
                                                          
                     
                     
                     
                     
                     
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