Georgetown International Youth Soccer
Camper and Family Information:

Camper’s Name

Camper’s Date of Birth

Gender: Male Female

Camper’s School

Camper’s Passport Number

GIYS Camps Previously Attended

Soccer Positions

Camper’s Allergies/Conditions

Parents’ and/or Guardians’ First and Last Name

Home Address

E-mail address

Home Phone Number

Cell Phone Number

Coach's Name

Coach's Email

Is the camper a U.S. citizen? (if no, you must check with your embassy regarding travel requirements)
Yes No

Emergency Contact Name (other than parents)

Contact’s Relationship

Contact’s Phone Number

Child's Physician

Physician’s Phone Number

Health Insurance Carrier

Insurance Policy/Group Number

Check here if you need transportation to camp ($50.00/Per Week)

Parental Permission and Release Statements:

If you are applying for the full summer package, the following form must be download, read, understood, completed, and notorized. You should then return it by mail to the address on the form:
Parental Permission Form (PDF)

Contact us if you’d like to plan parallel vacations for the parents.

The parent or guardian of the camper must read, understand, and agree to the following statements:

The parent or guardian must enter their name and the date below to indicate their agreement with the preceeding statements:

Name of Parent Guardian

Date

Payment:

Be sure to submit your payment as soon as possible. Included in all fees is a non-refundable $25.00 application fee.


Paying by Check:
Make check payable to "GYA, Inc.". Be sure to write the camper's entire name on the check, and send it to us via US Mail.

Check #

Amount

Print this completed appliction, and send it along with your payment to:
Georgetown International Soccer
7904 Woodrow Place
Cabin John, MD 20818

Additional:

How did you hear about us? (required)

Finish: