VIKING SOCCER CAMP

Application Deadline:  Register by February 28 and save $25! - Please get your application in early to reserve your spot

 

Payment accepted via Venmo (@Gherbert24) or check. Confirmation of application will be emailed within two weeks of receipt of the application along with a medical waiver to be completed and submitted before participation in camp.

 

Make all checks payable to Gregory Herbert.

 

Mail all registration forms and checks to:

Maureen Javers

6253 Clearwood Road

Bethesda, MD 20817

 

For more Information contact us at wwgsclinc@yahoo.com or Greg Herbert at gherbert24@gmail.com

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REGISTRATION FORM

(Please write legibly)

Viking Soccer Camp

 

Participants Name:_____________________________________________________________________________________ 

 

Address:________________________________________________________________________________________________

 

City:____________________________________           State:_____                   Zip:___________

 

Home Phone:____________________________________________

 

Parent Name and Cell Phone:___________________________________________________________________________

 

Parent Name and Work Phone: _________________________________________________________________________

 

Parent Name and Email:_________________________________________________________________________________

 

Parent Name and Email:_________________________________________________________________________________

 

Emergency Contact 1: _____________________________________________________________ Phone: ___________________________________

 

Emergency Contact 2: _____________________________________________________________ Phone: ___________________________________

 

Grade and School: (as of Sept 2024) _______________________________________________ 

 

Campers Last Tetanus Shot ________________________________________________________

 

Camper Allergies (please list if any): __________________________________________________________________________________________

 

Child’s Physician Name and Phone Number __________________________________________________________________________________

 

Child’s Age at the Start of Camp _____         Birthdate ________________

 

T-Shirt Size (circle):   Youth Small      Youth Medium         Youth Large         Adult Small

 

Participant in 8:00-9:00am early drop-off (add $25)?       YES           NO

Participant in 3:00-4:00pm late pick-up (add $25)?          YES           NO

 

PLEASE CHECK SESSION OR SESSIONS BELOW:

SESSION 1: JUNE 16 – JUNE 20                              ______            

SESSION 2: JUNE 23 – JUNE 28                              ______             

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WAIVER AND RELEASE

Acknowledging that participation in athletics carries with it a risk of injury, I agree that Viking Soccer Camp, Greg Herbert and its employees shall not be liable to me or my child for any injury or damage, howsoever caused, resulting directly or indirectly from my child’s participation in the Viking Soccer Camp at any time preceding, during, or after camp is in session and I hereby discharge Viking Soccer Camp, Greg Herbert and its employees from all actions, claims, and demands I or my child may have for any such injury or damage. I give consent to Viking Soccer Camp to use pictures of my child engaged in camp activities to promote future Viking Soccer Camp sponsored events.

Parent or Guardian Signature ____________­­­­______________________ Date________­­­____

 

CANCELLATIONS

All individual cancellations must be received in writing by mail or e-mail. Full refunds will be made for cancellations received at least 15 days before the camp begins. After this deadline, a $150 fee will be deducted for administrative expenses. For purposes of a refund, the postmark of the cancellation letter/email will determine the date received by the Viking Soccer Camp office. Campers who do not attend camp and fail to notify the Viking Soccer Camp office will not receive a refund. Campers who are injured and choose to remain for the duration of the camp will not receive a refund. All refunds will be completed by early September.