Participant Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Will you be paying by check or credit card? *

If you are paying by CC, upon completing this registration form you will be brought to a button to bring you to our online payment portal. If you are paying by check, all checks can be made out to The Fieldhouse at Homestead Mills and be mailed to 2 South Winchester Street, Swanzey, NH 03446. All checks must be delivered on or before the date of the camp. It is $180 to register for our Just4Keepers Goalkeepers Clinic.

Credit Card

Check