Terry Venables School of Soccer Application Form

Name 

Address 

City       State      Zip

Date of Birth           Male            Female 

Parent / Guardian 

Home Phone        Business Phone 

Email Address 

PLEASE CHECK ONE

Salisbury State Residential Camp        Boarder ($495)         Commuter ($350)
Arkansas Residential Camp (Boys)     Boarder ($350)          Commuter ($350)
Belmont Abbey Residential Camp       Boarder ($495)         Commuter ($350)

     Field Player                     Goalkeeper

Free Camp T-Shirt:     AS           AM          AL           AXL
Free Camp Shorts:      AS          AM          AL            AXL

  Camp Soccer Ball  $25 (please enclose payment)     Will bring my own ball to camp                     

Roommate preference 

A deposit of $100 is required with each application and will be subtracted from the total fee but is non-refundable. Please make checks payable to Terry Venables Soccer. If you are sending in an application after June 15, 2001, you must send in the TOTAL fee, not just the deposit. There is no deadline on applications.

OFFICE USE ONLY

Deposit / Full Payment     Check#    Date rec'd 
Applicable Discount  
Balance       Check#    Date rec'd