Ziemer.com | Online Registration Form

City of Santa Rosa 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
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Session Select Session (s)

July 26 - July 29, Sonoma Academy, Camp 4
August 2 - August 5, Galvin Park, Camp 5

Price: Resident $125, Non-Resident $135
Multiple Camp Discounts
2 weeks - Resident $115, Non-Resident $125
3 weeks - Resident $105, Non-Resident $115
4 weeks or more - Resident $95, Non-Resident $105
T-shirt is an additional $10 per camper

Residents Only Please Select One

Number of session (s) selected
Resident Camp Only	Resident With Optional T-Shirt and Camp
1 session, Resident ($125.00)	with optional t-shirt and camp ($135.00)
2 sessions, Resident ($230.00)	with optional t-shirt and camp ($240.00)
3 sessions, Resident ($315.00)	with optional t-shirt and camp ($325.00)
4 sessions, Resident ($380.00)	with optional t-shirt and camp ($390.00)
5 sessions, Resident ($475.00)	with optional t-shirt and camp ($485.00)

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 ($250.00)	with optional t-shirt ($260.00)
3 session, Non Resident ($345.00)	with optional t-shirt ($355.00)
4 session, Non Resident ($420.00)	with optional t-shirt ($430.00)
5 session, Non Resident ($525.00)	with optional t-shirt ($535.00)

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:
Z-Soccer
PO Box 14900
Santa Rosa, CA 95402
Make checks payable to Z-Soccer

Check Number:


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