SOCCER GOALS
TRAINING EQUIPMENT

YOU MAY APPLY OVER THE PHONE
CALL US NOW TOLL FREE AT 1-800-KEEPER-1
Please call 1-800-KEEPER-1 to check on availability
If you want to mail or fax in your application, please choose to download the printable version, complete and mail or fax that one-page application to us.
> Printable Camp Application (.pdf) - Click Here
> Looking for the Day Academy? - Click Here

A. Student Information * Student's First Name  * Student's Last Name * Street Address * City * State *  Zip E-mail Address Gender: * Male Female Date of Birth: (mm/dd/yy) ? 01 02 03 04 05 06 07 08 09 10 11 12 * Month ? 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 *  Day ? 99 98 97 96 95 94 93 92 91 90 89 88 87 86 85 84 83 82 81 80 79 78 77 76 75 74 73 72 71 70 69 68 67 66 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 * Year T-Shirt Size:  Size YouthLarge Small Medium Large X-Large * Each Camper will receive a FREE Short-Sleeve adidas T-Shirt   I am one of the following:  Choose One Goalkeeper FieldPlayer Coach   * Roommate Request: (If Applicable) B. Parent or Guardian  The school participant is in good health and has my permission to participate in camp activities. In the event of an emergency, I hereby give permission to the physician selected by the camp director to secure proper treatment for the student. All pictures or videos taken at camp may be used at the discretion of SoccerPlus.  Name of Parent or Guardian  (Required if Student is younger than 18)  * Home Phone Number  Cell Phone Number C. Program Choose one * GOALKEEPER SCHOOL Challenge Program - Commuter    ($670 in CA) $640 Challenge Program - Resident      ($770 in CA) $740 Competitive Program                  ($810 in CA) $780 National Training Center             ($830 in CA) $800 Advanced National Training Center            $1,225 Two Week Academy                  $1,500 FIELDPLAYER ACADEMY FieldPlayer Academy - Commuter  $640 FieldPlayer Academy - Resident    $740 Striker Program                        ($780 in CA) $750 Two Week Academy $1,500 COACHES' PROGRAM Coaches' Program - Commuter       ($530 in CA) $500 Coaches' Program - Resident        ($630 in CA) $600 TEAM PROGRAM Team Week (Northfield Mt. Hermon, MA) August 16-21 only $540 > 15-20 Players For Each Team  Use Printable Application (.pdf) - Click Here each D. Location and Dates Choose one   State - Location - Date CA1 - UCSD, San Diego July 12-17 CT1 - Suffield Academy June 21-26 CT2 - Suffield Academy August 2-7 CT3 - Suffield Academy August 9-14 CT 2 Weeks - Suffield Academy August 2-14 GA - Darlington School, Rome June28-July3 IN - DePauw Univ, Greencastle July 5-10 MA1 - Northfield-Mt. Hermon, Northfield July 5-10 MA2 - Northfield-Mt. Hermon, Northfield August 2-7 MA3 - Northfield-Mt. Hermon, Northfield August 9-14 MA 2 Weeks - Northfield-Mt. Hermon, Northfield August 2-14 ME - Bowdoin College, Brunswick July 26-31 NY1 - Colgate Univ., Hamilton July 19-24 NY2 - Colgate Univ., Hamilton July 26-31 NY 2 Weeks - Colgate Univ., Hamilton July 19-31 OH - OH Wesleyan Univ., June 14-19 PA - Bloomsburg Univ, Bloomsburg June 21-26 RI - Roger Williams Univ, Bristol July 12-17 TX - Texas Christian Univ, Fort Worth June28-July3 * Note: Please make sure that the program you wish to attend is being held at this location and is still available. For Example: The Striker School is only available at 7 locations. Visit the Schedule Page to check on  availability or call us toll free at 1-800-KEEPER-1. Note: If you are applying for a 2-Week program, please use the comment section below to indicate the program of choice for the first week and for the second week. Call us toll free at 1-800-KEEPER-1 with any questions. E.  Payment SoccerPlus uses Secure Socket Layers (SSL). By using a SSL we ensure that your credit card number is safe. Your credit card number and any information you enter into this form will only be seen by SoccerPlus Camps. I am paying one of the following: * (Full tuition required if applying within 30 days of camp) $250 Non-Refundable Deposit ($500 deposit for 2-Week Academy) Refund Policy Full Tuition I also want to buy an official  SoccerPlus/adidas Camp Ball  for an additional $25 (Note: By selecting "Yes", you will be  charged $25 in addition to the camp tuition) No Yes OPTIONAL In addition to my FREE t-shirt, I also  want to buy a SoccerPlus/adidas  Long Sleeve Training Jersey for an additional $25 (Note: By selecting a size, you will be charged  $25 in addition to the camp tuition) None Youth L S M L XL OPTIONAL $35 value! I will be using the following type of credit card: * Visa      MasterCard     Discover Credit Card Account number:                               * (Example: 0000-0000-0000-0000) Credit Card Security Code:  (This is the 3 digit number on the back of your card) Credit Card Expiration Date:    01 02 03 04 05 06 07 08 09 10 11 12 * Month    2008 2009 2010 2011 2012 2013 2014 * Year Name of Card Holder:  * Check here to automatically pay your balance: Yes, please automatically charge the balance to my credit card 30 days prior to the camp start of camp. The confirmation package will include a confirmation letter, a map to and of the campus, a medical form, what to bring list, and pre-camp tips and advice. Note: If applying for our Two-Week Academy, please identify below which program you would like to attend for each week. If you have any questions, please contact us at 800.533.7371. Type any comments in the field below: Please Note: After submitting this application the SoccerPlus Office Staff must process your information before the student is enrolled in camp.  You will be directed to a receipt/page of your application.