2023 Jersey Blues Soccer Summer Camp - Fundraiser

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Email address *

First name *

Last name *

Address 1 *

Address 2 *

City *

*Camp Dates and Time:

Monday - July 17, 2023: 9am-12pm

Tuesday - July 18, 2023: 9am-12pm

Wednesday - July 19, 2023: 9am-12pm

*Rain Date:

Thursday, July 20, 2023: 9am-12pm

*Location:

Brookdale Community College

765 Newman Springs Road

Lincroft, NJ 07738

Parking Lot 5 - Grass field across from High Tech High School

First Name of Camper *

Last Name of Camper *

Age of Camper *

Guardian's First Name *

Guardian's Last Name *

Medical Information (Epi pen, Inhaler, Other) *

Will Camper Attend Camp on Monday - July 17, 2023 *

Yes No

Will Camper Attend Camp on Tuesday - July 18, 2023 *

Yes No

Will Camper Attend Camp on Wednesday - July 19, 2023 *

Yes No

Emergency Contact Name *

Emergency Contact Number *

* required field