2025 Summer Soccer Camp Registration

Child #1 *

First Name

Last Name

Child #2 (if applicable)

First Name

Last Name

Child #3 (if applicable)

First Name

Last Name

Choose Session(s) : Choose one or both *

GIRLS; Ages 10-14; June 30th - July 3rd - 4 days; Field TBD in Costa Mesa/ Newport; 9-11am; Intermediate / Advanced. $325

GIRLS; Ages 10-14 5 days; July 14-17; Field TBD Costa Mesa / Newport Beach; 9-11am; Intermediate / Advanced $325

GIRLS; Ages 10-14; August 4-7 Field TBD Newport Beach /Costa Mesa 9-11am Intermediate / Advanced $325

BOYS; Ages 10-14; July 18-19; Field TBD Newport Beach/ Costa Mesa; 9-11am Intermediate / Advanced. $200

BOYS; Ages 10-14; August 8-9; Field TBD Newport Beach / Costa Mesa 9-11am Intermediate / Advanced. $200

Parent Name *

First Name

Last Name

Phone *

(###)

###

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Home Address (needed only in case we get audited by city of Costa Mesa Parks & Recreation Department for requirements around having a percentage of kids from Newport/ Costa Mesa) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Payment Method ( Payment Needs to be completed by August 5th to take advantage of Early Early Bird Pricing) *

Zelle (209-327-3482)

Venmo (Patrick-ianni)

Waiver of General Liability *

By checking this box, I am releasing Patrick Ianni, Pristine Vibrations LLC, and their staff from any liability for my child's participation in any soccer or non-soccer related activities and any resulting injuries that take place prior, during or after their time associated with Pristine Vibrations LLC (also Ianni Training) activities. I also understand that there is an inherent risk in playing sports.

Parent Signature For Waiver Above *

First Name

Last Name