Parent Name *

First Name

Last Name

Phone *

(###)

###

####

Athlete Name *

First Name

Last Name

Athlete Birthdate *

MM

DD

YYYY

Camp Days Attending *

November 19th

November 20th

November 21st

Payment Authorization *

I understand that by submitting this Registration Form, I authorize Salcianu Elite to charge my account for the Thanksgiving Day-Camp dates selected.

I Agree