Camp Selection

Please make a camp selection. Please note, there is a $10.00 online processing fee include in each online camp payment.

Please complete the correct form and submit your payment to reserve your space before the camp deadline. If you are paying a deposit at this time, full payment may be made prior to camp or at camp registration. A $30.00 late charge will be added for registrations and deposits received after the deadline. Click Here for camp deadlines.


June 16-20 (VMI) Residential - Pay in Full: $500.00
June 16-20 (VMI) Residential - Deposit: $110.00
June 16-20 (VMI) Commuter - Pay in Full: $450.00
June 16-20 (VMI) Commuter - Deposit: $110.00
June 16-20 (VMI) Elite - Pay in Full: $600.00
June 16-20 (VMI) Elite - Deposit: $110.00
June 20-24 (USC Aiken) Residential - Pay in Full: $500.00
June 20-24 (USC Aiken) Residential - Deposit: $110.00
June 20-24 (USC Aiken) Commuter - Pay in Full: $450.00
June 20-24 (USC Aiken) Commuter - Deposit: $110.00
July 18-22 (Hollins) Residential - Pay in Full: $500.00
July 18-22 (Hollins) Residentil - Deposit: $110.00
July 18-22 (Hollins) Commuter - Pay in Full: $450.00
July 18-22 (Hollins) Commuter - Deposit: $110.00

July 23-29 (Elite Camp - Hollins) -Submit Registration Details

*IMPORTANT! Payment for this camp must be made by check only! Please make your $1000.00 check payable to Ben Freakley School of Soccer and send it to: 121 Tillman Rd., Unit 501 / Statesboro, Ga. 30458
SPACE IS LIMITED FOR THIS CAMP AND REGISTRATIONS ARE GUARANTEED ON A FIRST COME, FIRST SERVED BASIS!

 

*Registration for all 2010 Overnight Camps begins at 1 p.m. and concludes with closing ceremonies at 11 a.m.

Please note: All deposits are non-refundable, but are applied toward balance owed. Click here to view our refund policy (scroll to the bottom of the page to see it!).

Choose Your Payment Option

Pay for my child to attend camp.
Mailing a Check to BFSS.
Pay for another child to attend camp (Gift Certificate).

Billing Information

Name as it appears on credit card


First Name
Last Name

Billing Address


Address

Address Line 2

City
Billing State

Zip Code
Country

Telephone Numbers


Home Number

Work Number

Cell Number

E-Mail Address

Credit Card Information


Type:    Visa     Master Card     American Express     Discover   


Credit Card Number
 / 
Expiration (mm/yyyy)
CVV Code

Parent / Guardian Information

Check this box if the following information and your billing information are the same.

Name


First Name
Last Name

Mailing Address


Address

Address Line 2

City
Mailing State

Zip Code
Country

Telephone Numbers


Home Number

Work Number

Cell Number

E-Mail Address

Camper Information

Camper's Name


First Name
Last Name

Camper's Age

Camper's Gender

Male Female

Camper's Birthday

 /   / 

Camper's Grade as of Sept 2010

Camper's Email

Emergency Contact Information

Name of Parent/Guardian


First Name
Last Name

Relationship to Camper


Contact Phone Number

Cell Phone Number

Contact Email

Medical Information

Emergency Contact


Contact Name

Contact Number

Health Insurance Provider for Camper

Policy Name (Whose name is the policy filed under?)

Insurance Policy Number

Allergies, Medications, or Other Conditions (please list anything you'd like us to be aware of in case medical treatment becomes necessary)

Medical Authorization

By clicking on the box to the left and entering my name and today's date into the fields below, I / We, the undersigned hereby certify that I (We) am (are) the parent or legal guardian of the camper. I hereby give my permission for the staff of the camp,during the period of the camp, to seek appropriate medical attention for the camper, and for medical attention to be given, and for the camper to receive medical attention in the event of an accident, injury or illness. I / We will be responsible for any and all costs of medical attention and treatment, and have medical insurance to cover these costs. I / We understand, as with any sport, injuries can occur, and we hereby acknowledge that our child is physically fit and mentally capable of participating in soccer and camp activities.

Full Name
Date

Photographic Release

By clicking on the box to the left and entering my name and today's date into the fields below, I hereby agree to the following statement: For Good and valuable consideration, the receipt of which is hereby acknowledged, I (as the parent or legal guardian of the camper named in this application) hereby grant and convey to the Ben Freakley School of Soccer all right, title, and interest in and to record my child's name, likeness, image, voice, statements, and/or writings including any and all photographic images and video or audio recordings made by Ben Freakley School of Soccer. I further grant to Ben Freakley School of Soccer, its advertisers, customers, agents, successors and assigns, unrestricted rights to use the above mentioned sounds, still, or moving images in any medium, including but not limited to, external or internal print media or posting on the Internet and World Wide Web, for educational, historical, archival, promotional, advertising, or other purposes, without limitation, consistent with the mission of the School. I agree that all intellectual property rights to the sound, still, or moving images belong to Ben Freakley School of Soccer. I voluntarily waive any right to any royalties, proceeds or other benfits derived from such photographs or recordings and agree that I shall receive no compensation fro my/ or my child's appearance and participation.

Full Name
Date
 
© 2010 Ben Freakley School of Soccer
Website Design by Joel Balthaser