Registration Form

 




 

 

 

 

Name
Address
City
State Zip Code
Gender
Age
Date of Birth
Home Phone
 
Parent Name
Work Phone
 
Parent Name
Work Phone
 
Email Address
   
Team Name
Coach Name

How did you hear about Flawless Soccer?

REGISTERING FOR:

July 14 - 18, Leesburg VA Day Camp
July 14 - 18, Leesburg VA Soccer4Kinds
July 21 - 25, Leesburg VA Day Camp
July 21 - 25, Leesburg VA Soccer4Kids

Note that summer camp participants must complete a registration packet including more details about camp, emergency contact sheets and medical forms. Upon receipt of this web form you will be mailed a registration packet (one will be posted for download soon). All forms must be received prior to the start of camp to comply with state laws.

 

If this online form does not work for you, please check your internet browser configurations. You may also:

  • send an email directly to ogedegbe@flawless-soccer.com which includes the information requested above
  • email a request for a brochure to be mailed to you
  • give us a call at 703 669-0726
  • print out the form and mail it with payment to: PO Box 502, Leesburg, VA 20178