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Pittsburgh Premier Soccer
SUMMER CAMP 2012

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SUMMER DAY CAMP
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Please submit a separate form for each child, noting a $15 off discount for each additional child from the same family. Send payment to "PPGSC", 3 Elm Lane, Leetsdale, PA, 15056

	Please sign me up for Summer Day Camp, August 27 to 31, 9 am to Noon
Child's First Name:
Child's Last Name:
Address Street 1:
City, State, Zip:
Parent(s) or Guardian:
Phone 1:
Phone 2:
Email:
Date of Birth (mm/dd/yyyy)
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