Waiver Statement:

I understand that I will provide and pay for all medical treatment for my child/ ward and I will not hold the soccer camp, Blythewood High School, Richland District 2, its respective employees, and or agents therefore liable for injuries incurred while my child/ward is attending soccer camp.

Signature of Parent/Guardian

Date

In order to receive a camp T-shirt, all application information and money must be received by June 5, 2009. Late applications will not receive a T-shirt. Applications will be accepted until the first day of camp. There is a $10 discount for siblings.

Make checks payable to Wittig Camps.

Send payment and application to:

Coach Peter Wittig

1 Windy Knoll

Columbia, SC 29229

Camp Director Peter Wittig Blythewood High School Boys Varsity Coach 1 Windy Knoll Columbia, SC 29229 USA

COACHING STAFF

Camp Information

Cost: $60.00

Ages 6-13

June 15-18

5:00 - 8:00pm

Every player must bring their own soccer ball, shin guards, and water bottle. The dress should be athletic shorts, t-shirt, soccer cleats and/or tennis shoes (in case of bad weather, we will go inside). Make sure the player’s name is written on all equipment. Players must be dropped off between 4:45 and 5:00, and they must be picked up by 8:15.

Registration Information

Camper Name Address

Age & Grade in Fall Parent/Guardian’s Name Phone: Home/Work or Cell

T-Shirt Size: (Circle one only)

Youth Sizes: S M L Adult Sizes: S M L XL