Please type in all available boxes, print page, then sign the waiver below.
Mail with Check payable to:
Phillip Gyau
13115 Tamarack Rd.
Silver Spring, MD 20904
Next Level Development/St. John's Soccer Accademy Registration Form
Player's First Name: Player's Last Name:
Parent First Name: Parent Last Name:
Email:
Date of Birth: Age:
Address:
City: State: Zip:
Telephone (H) : - - Telephone (W) : - -
Please check the camp dates you wish to attend:
June 25 - June 29 ~ 5pm - 8pm $175
July 2 - July 6 ~ 9am - 3pm $250
July 30 - August 3 ~ 5pm - 8pm $175



Important - Read and Sign Liability Waiver
I hereby release St. John's High School and Next Level Development and any persons directly involved with this program from any liability and/or medical payments sustained through my child's participation in this program. I hereby certify that my son is in good physical condition to participate in this program.


____________________________                ____________________________
Print Player/Parent Name (if under age 18)                Player/Parent Signature (if under age 18)
FOR OFFICE USE ONLY
Date Paid:_____________
Amount Paid:___________
Check #:________
Please note we only accept:
Checks (made payable to Phillip Gyau)