Soccer Player Information

First Name	Initial
Last Name	Age
	Male Female
Street Address & City/State/Zip

Parents/Guardian

Name
Street Address & City/State/Zip
E-mail Address
Home Phone
Work Phone
Cell Phone

Moravek Soccer Summer Academy Programs

	Ages 6–12	9:00 am–3:30 pm each day
	Ages 6–12	9:00 am–12:00 pm each day
	Ages 3–5	9:00 am–10:30 am each day
June 22–26 Purcellville, Franklin Park
June 29– July 3 Purcellville, Franklin Park
July 6–10 Sterling, Claude Moore Park
July 13–17 Sterling, Claude Moore Park
July 20–24 Ashburn, Ashburn Elementary School
July 27–31 Ashburn, Ashburn Elementary School
August 3–7 Leesburg, Leesburg Annex
August 10–14 Leesburg, Leesburg Annex
August 17–21 Leesburg, Leesburg Annex
August 24–28 Purcellville, Franklin Park
After registering, participants will NOT receive confirmation of enrollment unless requested.
2009 Residential Camp Dates
July 26–August 1 Premier Advanced Camp: Boys Ages 9–18 (Sunday-Saturday) Frostburg State University, Frostburg, MD August 2–August 8 Premier Advanced Camp: Boys Ages 9–18 (Sunday-Saturday) Frostburg State University, Frostburg, MD Premier Advanced School: $500.00 per student Siblings: $465.00 per student, Two week participants $465.00 per student Team with 10 or more: $465.00 per student
Roommate Request — Residential Camp   A $100.00 is deposit required with your application. The balance is due on first day of camp. No refunds give after registration. Every student must get a full physical before attending camp and provide it to the staff on the first day of registration.
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