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NIU Camp Info

LIL Dribblers

Space is Limited - Register Soon!

Ages: 4-6 years old
Winter 2012 Session
Cost: $65
(Includes T-Shirt)

For additional information, or to register your child, either download and complete the LIL Dribblers Registration Form, or complete and submit the online form below.

 
Player Name
Parent Name
Shirt size
Date of Birth
Address
City
Zip
Home Phone
Alt. Phone
Email Address
I hereby give permission and certify that my son/daughter is in good health and able to participate in all activities. I hereby release Northern Illinois FC, coaches, staff, and all other identities associated with the class of all liability for any injury or illness incurred by my child at the camp. In case of emergency, I grant permission for my son/daughter to be given emergency treatment at a local hospital.
Parent/Guardian Signature (Checking this Medical Release box is the electronic equivalent of a physical signature)
Date
Card Type: (Master Card / Visa)  I hereby authorize you to charge my credit card (Checking this box is the equivalent of an electronic signature)
Exp. Date
Card #
(3 digit # on back of card) Signature
 
 

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