Duperier Soccer Camp Academy

* required field information.

Camp Registration

To register electronically, please complete the following form and click submit.

Then send a copy of this completed form along with a non-refundable check for a deposit of $100 for each session to:

THE DUPERIER SOCCER CAMPS ACADEMY - 7221 Pyle Road - Bethesda, MD 20817
Name of Camper *

Name of Parent/Guardian *

Home Address *

City *

State *

Zip Code *

Home Phone *

Mobile Phone *

Age at Camp *

Sex *

Male Female

Applicant's Email address *

SESSION ATTENDING:
Summer Individual Camp *

June 28 - July 2
July 12 - 16
July 26 - 30
August 2 - 6

TUITION SELECTION (price per week):
Full Day: 9:00 am - 5:00 pm

$285 $305 with ball

Part Day: 9:00 am - 3:00 pm

$250 $270 with ball

Shirt Size *

S M L XL

The applicant is in good health and has parental/guardian permisssion to participate in this program and engage in all the prescribed activities. In the event of injury or sickness, the applicant's insurance policy is the primary coverage.

Applicant's Medical Insurance Policy Information:
Insurance Carrier *

Policy Number *

I assume all risk and hazards incidental to my child/ward's participation in the soccer camp. I hereby waive and release Duperier Soccer Camps, LLC and its principals, agents, staff and contractors from any liability for any and all injuries sustained while attending the camp. I accept full responsibility for my child's medical bills and all other expenses associated with or incurred as a result of injury or illness while attending the Camp. In the event that the parent/guardian cannot be reached in an emergency, I hereby give permission to the physician selected by the Camp to hospitalize and obtain proper treatment for (including injection, anesthesia or surgery) for the camper as needed and will be responsible for all the associated costs.
Signature of Parent/Guardian *

Date *

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