CISA Summer Camp Online Registration

2019 Summer camp registration is active. Please fill out the form below, and you will be asked to select your camp of choice (Kicking Kids, Junior Day Camp, Youth Commuter Camp, or High School Boys Camp) during the payment process, please contact Tim at tregan@fsmail.bradley.edu with questions.

Early registration discounts are currently active for the high school boys camps.

Step 1 of 3 - ** You will choose the specific Camp during Step 3

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Player Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Birth Date*
MM
DD
YYYY
Age*
Gender*
- Male
- Female
Grade*
Position*
- Field Player
- Goalkeeper
Team Name
T-Shirt Size*

Parent Contact Information
Parent/Guardian Name(s)*
Daytime Phone*
Emergency Contact Name*
Emergency Contact Phone*
Email*
Medical Insurance Information
Medical Insurance Requirement
It is the responsibility of the camper's parents or legal guardians to ensure that the camper is healthy and has no physical problems, which would prevent the camper's participation in camp activities. Responsibility for primary medical coverage rests with the camper.
Medical Insurance Company*
Policy Holder*
Policy Number*
Medical Release Waiver
Medical Liability Waiver
This certifies that the participant listed above has had a physical examination by a licensed physician in the past year and is free from any illness or injuries that would prevent him/her from participating in any activities at the Central Illinois Soccer Academy while my son/daughter/ward is present at camp.
Name of Parent/Guardian*
Do you agree/confirm the terms of the medical release waiver?*
- Yes
Today's Date 05/20/2019

Camp Selection
Camp Selection*
Early registration discounts available until June 1st, 2019
Roommate Name
Billing Information
Total To Be Charged To Card
$0.00
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CISA Summer Camp Online Registration

Step 1 of 3 - ** You will choose the specific Camp during Step 3

Parent Contact Information

Medical Insurance Information

Medical Release Waiver

Camp Selection

Billing Information