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ENROLLMENT FORM
* - required fields
*Name:
*Address #1:
Address #2:
*City:
*State:
*Zip:
*Phone:
Alt Phone:
*Email:
Fax:
Date of Birth:
Age:
Sex: Male Female
Height:
Weight:
Position:
T-Shirt Size:
Parent/Guardian:
School/College:
Address:
Coach:
Team:
High School: District State Regional National
Club - Name:
College: Division I Division II Division III
Achievements:
Goals:

Please enroll me in the:

Individual Players Program
One month (Romania and Portugal), 6/27-7/23/17
3 weeks (Portugal), 7/08 - 7/26/17
4 weeks (Spain and Portugal), 7/08 - 8/05/17
12 days (Spain), 7/25 - 8/05/17
12 days (Portugal), 7/15-7/25/17
5 weeks (Romania, Spain and Portugal), 6/27- 7/30/17

Jr. HS, HS, College & Club Team Program
12 days (Spain) 3/27 - 4/07/17
12 days (Portugal) 3/27 - 4/07/17
12 days (Romania), 6/22- 7/03/17
12 days (Belgium), 6/22-7/03/17
12 days (Spain) 7/25 - 8/05/17
12 days (Portugal) 7/15-7/25/17
Do you prefer different dates? We can help!

Choose:
Field Player
Goal Keeper

With your enrollment you must enclose a non-refundable $650 deposit to reserve your position. Installment payment plan available Checks are payable to Eurosoccer Academy of the USA. Major credit cards accepted. Upon receipt of your deposit we will send you a complete information book and account statement.

EUROSOCCER ACADEMY of the USA
305 Steven Lane
Stroudsburg, PA 18360
Phone 570-807-6187

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