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You may register online or mail a hardcopy. (we suggest the latter)
It appears that this online form does not work for people using Apple. Apple users to contact us directly at 10ten@myfairpoint.net

First Name Last Name
Gender Grade entering Birthdate
Address City State Zip
E Mail Home Phone 2nd Phone
Position Played

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2012 Dates
Week One     Girls Entering Grade 4 -12 and Boys Entering Grades 4 – 8     July 15 - July 19th
Week Two     Boys Entering Grades 9 – 12 and College Freshmen     July 22 – July 26th

Check preferred program:
Cost Week One: Reduced price! $450.00 for residents of Vermont $475.00 for non residents
Week Two: $500.00 Early registration (Prior to March 15th) $525.00 after

Requested Roommate
Must be reciprocal. Please ask requested roommate to request you as well.

Guardians Name Relationship
Home phone Work phone

Emergency contact; Name Emergency contact; Phone
Medical Insurance Company Policy #
Name of policyholder
Instructions regarding insurance

Please notify notify us ASAP of any unusual medical conditions or dietary requirements. All medical and disclaimer forms will be completed at time of registration. Updated insurance information will also be completed at this time.

Once submitted, if you do not receive confirmation within 7 business days, please email 10ten@myfairpoint.net or call 802-309-3983 to confirm status. If phone mail box is full please call Andy McCabe, Middlebury College Soccer Recruitment Coordinator, 802 233 3924.

All fields are manditory, please make sure they are complete.
    
All information will be treated as confidential.

Vermont Soccer School
David Saward
Middlebury College
Middlebury VT. 05753