Ziemer.com | Online Registration Form

City of Petaluma World Cup Soccer Camp

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Camper/Parent Information

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in this field to continue:

(all UPPER case)

Check Appropriate
button (s)

Session Select Session (s)

July 26 - July 29, Prince Park, Camp 6P
August 2 - August 5, Prince Park, Camp 7P
August 9 - August 12, Prince Park, Camp 8P

Petaluma United & PYSL members $95, Non-members $135
2 weeks - SCA, Petaluma United and PYSL members $85/week, Non-members: $120/week
3 weeks - SCA, Petaluma United and PYSL members $75/week, Non-members: $110/week
4 weeks or more - SCA, Petaluma United and PYSL members $65/week, Non-members: $100/week
T-shirt is an additional $10 per camper

Residents Only Please Select As Many That Apply

Number of session (s) selected
Resident Camp Only	Resident With Optional T-Shirt and Camp
1 session, Resident ($95.00)	with optional t-shirt and camp ($105.00)
2 sessions, Resident ($85x2=$170)	with optional t-shirt and camp ($180.00)
3 sessions, Resident ($75x3=$225)	with optional t-shirt and camp ($235.00)

Non-Residents Only Please Select One

Number of session (s) selected
Non-Resident Camp Only	Non-Resident With Optional T-Shirt and Camp
1 session, Non Resident ($135.00)	with optional t-shirt ($145.00)
2 session, Non Resident ($120x2=$240)	with optional t-shirt ($250.00)
3 session, Non Resident ($110x3.$330)	with optional t-shirt ($335.00)

Yes, I would like an optional t-shirt:

If Optional T-shirts was selected please select size:

Camper Name:

Street

City:

State:

Zip

Parent Name:

Phone: (Daytime):

Phone (Evening):

Emergency Phone:

Date of Birth:

Gender:

Email Address:

Payment Information:

Comments:

Credit Card Payment - Due to security purposes, we will call you for your credit card information.

Check Payment - Please Mail Check to:
SCA - Winter Camps
P.O. Box 905
Petaluma, CA 94953
Make checks payable to SCA

Check Number:


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