Register for Camp

Please complete the registration form and click the Submit button. You will be forwarded to a page containing links to download the Emergency Data and Liability Waiver Form.

We must have the completed paperwork and full payment no later than 7 days before the beginning of camp.

Camper's Information
	Child's Name*:
	Birth Date*:
	Sex:	Male Female
Parent's Information
	Parent/Guardian*:
	Address*:
	Address:
	City, State*:
	Zip*:
	Home Phone:
	Work Phone:
	Cell Phone:
	Email*:
Camp Selection		Please click the week or weeks that you wish to attend camp. Half-day camps are for 6 year-olds only.
		19 July to 23 July, Full Day 19 July to 23 July, Half Day 26 July to 30 July, Full Day 26 July to 30 July, Half Day 2 August to 6 August, Full Day 2 August to 6 August, Half Day
How did you find out about Chip Rohr Soccer Camp?		Print Advertising Brochure Roadside Sign Linton Hall School Chamber of Commerce Word of Mouth Other (please indicate below)

Payment Information
	Payment Method:

* indicates required information.

A $25 non-refundable downpayment is required to register for each week of Chip Rohr Soccer Camp. This deposit will be applied to the camp fee.

We do not accept credit card payments; however, we will gladly accept your money order or personal check made payable to Chip Rohr Soccer. A fee of $35 will be assessed against all returned checks. Checks and money orders should be made payable to Chip Rohr Soccer and sent to P.O. Box 71, Manassas, VA 20108-0071.