Mount Vernon Nazarene University: Athletics: Cougars

Men's Teams

Women's Teams

Cougar Soccer Camp

Please register one person per form.

Name:
Age:
Grade in Fall '13:
Gender:	Male Female
Address 1:
Address 2:
City:
State:
Zip:
Home Phone:
Emergency Phone:
Email:
T-Shirt Size:
Quality Camp Ball available for purchase for additional $20:	Yes No

Liability Release Form I, the undersigned, hereby release Mount Vernon Nazarene University from all liability of injury arising from participation of or incident to the above-named child at the Cougar Soccer Camp. I also authorize Mount Vernon Nazarene University personnel to seek and obtain medical aid for said youth if in their judgement such action is warranted, should the child sustain an injury while participating in a team-sponsored soccer activity. I further agree to subrogate them in any loss sustained by them personally out of my child’s participation.
	I agree to the above Liability Release Form.
First Name:
Last Name:
Date:

Cost $99 before June 15, 2013 $110 after June 15, 2013 There is a $10 discount for additional family members and Mount Vernon Soccer Association members.

Discount:	Check this box if this registration is for an additional family member or if you are a Mount Vernon Soccer Association member.

Total:	$
Pay by:	Credit Card Online Check Online Check by Mail





Questions?	Contact Andrew Belleman at (740) 397-9000, ext. 3104, or e-mail andrew.belleman@mvnu.edu.