Learn from Olympic Coach Dennis Lukens and his Professional Staff

Cornwall on the Hudson, NY

Player Application:

Step 1 of 2 [ALL FIELDS REQUIRED]

Player's First Name:

Player's Last Name:

Player's Age:

Address:

City:

State:

Zip:

Parent Cell Phone #1:

(XXX) XXX-XXXX

Parent Cell Phone #2
Or other emergency contact #:

(XXX) XXX-XXXX

Email Address:*

Uniform Size:

X-Small	Large
Small	X-Large
Medium	XX-Large

Last Team Played For?

How did you find us?

Roommate Requested:

Camp Requested:

July 18 - 22, 2010, Cornwall on the Hudson, NY
July 25 - 29, 2010, Cornwall on the Hudson, NY

Camp Type:

Residential Camp
$490.00 Fee
$250.00 Deposit*

Day Camp
$295.00 Fee
$150.00 Deposit*

* Non refundable deposit.

My child is in good health and has my permission to participate in all camp activities. In case of emergency, I hereby give my permission to the Doctor, selected by the Director of Premier Plus Soccer Camp, to secure proper treatment. All pictures and videos may be used by Premier Plus Soccer Camps at their discretion.

No refunds, only a tranferrable credit towards a future camp at any of our locations.

Do you agree? Yes No

Camp Director, Dennis Lukens directed and produced the best selling soccer instructional video "World Cup to the Backyard" featuring members of the 1999 World Cup Champion United States Women's National Team.

*** Pay your balance here! ***

Outstanding Soccer Camps Since 1977