Grades: K-thru-6
Fee: $185 a week (Half Day $90)

Drills & Scrimmages at Takoma Park Middle School (9:00 - 3:30)
Chief instructor - the popular Adrian Baez, Einstein varsity coach

Director - Howard Kohn

Have Fun & Learn Soccer!!!!

July 23rd - thru - July 27th
and /or
July 30th - thru - August 3rd

* Full day (9:00-3:30) OR Half day (9:00-Noon) *

(First come, first served.  Each player will be sent an email with a full list of information.
For questions contact Howard Kohn at kohn@erols.com.)

Player's Name   Birth:    Grade    Gender

Names of Parents


Phone (home) (work)

E-mail address (important!)

Name & Number of Emergency Contact (during camp week):

Medical Needs or Other Special Information:

Did you also register separately for the TP Rec. Dept. before-care or after-care? before-care after-care neither

I hereby give my child permission to participate in this soccer program.  I understand that no accident insurance is provided, and I agree that I will not hold Takoma Soccer or the Takoma Park Recreation Department responsible for any injury sustained while participating in this program.

Signature of Parent or Guardian ______________________________________________

Fee: $185/week (Write checks to Takoma Soccer)
Mail to: Takoma Soccer, 16 Jefferson Ave, Takoma Park, MD 20912

NOTE: We need an original signature on the form.