LOWER MERION SOCCER CLUB
Box 360, Bryn Mawr, PA 19010

INTRAMURAL SOCCER CAMP REGISTRATION FORM


    PLAYER INFORMATION

    Last Name:   
    First Name:   
    Street Address:     
    Town, State and Zip Code:
     
    Primary Phone Number:
    E-Mail Address 1:
    E-Mail Address 2:
    Parents' Names:
     
    Gender:       Male Female



    PLEASE LIST PREVIOUS SOCCER EXPERIENCE (IF ANY),
    INCLUDING CLUBS, DIVISION AND YEARS PLAYED

    Please feel free to enter any additional comments here: