KERRIGAN SOCCER SCHOOLS, LLC
SOCCER CAMP AT XL Soccer World 
CAMPER APPLICATION FORM

Camper Name: _______________________________________

Address: ____________________________________________
City:__________________ State:______ Zip:________________
Parents’ name(s):_____________________________________
Parents’ Cell Phone(s) : ________________________________
Parents’ Home Phone: ( )_______________________________
Parent’s Work Phone: ( ) ________________________________
Parent’s email: (for camp information only & will not be sold/distributed)___________________________________________________

Age of Camper: _________Grade Entering Fall 2012: _________

How did you hear about our camp? ________________________

Position Played: _____ Goalkeeper ______ Field

Camp Session: June 25-29, 2012 
Camp Times: 9 a.m. – 12 p.m.
Camp Location: XL Soccer World

Applying For a Team Discount/Sibling Discount: If you are Applying for a Team Discount with 6 or more players, please list the team name, team contact, and team contact’s phone number. The discount will be applied AFTER we verify that you qualify for the discount.
________________________________________________________
________________________________________________________

Are you ordering a camp ball for $25?
_____Yes (add $25 to fee of $130 for a total of $155)
_____ No, I will bring my own ball to camp every day

Fill out and Return with Payment
($130 Tuition or $155 for Tuition and Ball)

To:

For more information or to register by phone, please contact:
Kerrigan Soccer Schools - 919/819-8347
laurakerrigan@nc.rr.com