Mt. Kisco Camp Registration

MT KISCO SOCCER CAMP — SUMMER 2025

Transylvania Gym & Soccer LLC / Rippowam Cisqua School, Mt Kisco, NY

REGISTRATION FEE: $325.00 / per session

To enroll in the program a parent/guardian shall complete the registration form and submit it online (by clicking “I AGREE”), and then mail the check (payable to TRANSYLVANIA GYM & SOCCER LLC) to the following address: TRANSYLVANIA GYM & SOCCER LLC, 11 Grace Court, Bethel, CT 06801

Age Groups & Sessions:

Session 1: July 7–11, 2025 — Morning 9:00–11:00 AM, born in 2017, 2018 & 2019
Session 2: July 7–11, 2025 — Morning 9:00–11:00 AM, born in 2014, 2015 & 2016
Session 3: July 7–11, 2025 — Afternoon 1:00–3:00 PM, born in 2012 & 2013
Session 4: July 14–18, 2025 — Morning 9:00–11:00 AM, born in 2017, 2018 & 2019
Session 5: July 14–18, 2025 — Morning 9:00–11:00 AM, born in 2014, 2015 & 2016
Session 6: July 14–18, 2025 — Afternoon 1:00–3:00 PM, born in 2012 & 2013

Primary Parent Name

Secondary Parent Name

Child's Name

Child's Date of Birth

LIST ALLERGIES AND/OR LIMITATIONS

Address

Emergency Phone Number

Home Phone

E-mail

Secondary Email

I am registering my child for:

By typing your name above as the parent/guardian, you agree with the terms outlined below. To enable the Town of Mt Kisco, Rippowam Cisqua School and Transylvania Gym & Soccer LLC to accept registration and permit participation in this program, I hereby release and agree to hold harmless the Town of Mt Kisco, Rippowam Cisqua School and Transylvania Gym & Soccer LLC, its officers, officials, employees and volunteers harmless from any and all liability, claims, demands, actions, or rights of action, which are related to, arise out of, or are in any way connected with participation in this activity. Should injury occur, I understand my health insurance is primary. Transylvania Gym & Soccer LLC will not be held responsible for any injury sustained by participants in our soccer program. I hereby authorize treatment and care of player by any hospital, doctor, or emergency or ambulance association.

Parent/Guardian Signature

Thank you! Your submission has been received.