Please send completed form in with payment by May 18th:

Player’s Name: __________________________ Contact Number: _____________________________

Grade in 2018 - 2019: _____________________ T-Shirt Size: __________________________________ (Please indicate Youth or Adult)

Medical concerns staff should be aware of: ______________________________________________________

✓ Please make checks payable to Kyle Conley – LHS Soccer

✓ Please return completed forms & payment no later than May 18th Louisburg Soccer Camp – Kyle Conley 402 Lakeview Drive Louisburg, KS 66053

✓ Any questions may be directed to Kyle Conley (785) 418-3090 or conleyk@usd416.org

I certify that ___________________________ has my permission to participate in the Louisburg High Soccer Camp. I grant permission to the coaching staff to act on my behalf, according to their best judgment in any case of emergency requiring medical attention and waive the coaching staff and Louisburg High School from any liability for injuries while at camp.

Parent/Guardian Name: ________________________________________________________________________

Parent/Guardian Cell Phone Number: _____________________________________________________________

Parent/Guardian Email Address: __________________________________________________________________

Parent/Guardian Signature: ____________________________________________ Date: _______________

What will my camper receive? A fun-filled environment Quality Coaching Skill Competitions Small-Sided Games Camp T-Shirt

What does my Camper need to bring? Shin-guards Soccer cleats (if you have them) Water bottle Positive Attitude Boys & Girls 1st – 5th grade will need

to bring their own soccer ball

Take Wildcat Drive or S 5th Street E to S Countryside Drive