2025 High Vibes 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 *

June 17-20

July 21-24

Parent Name *

First Name

Last Name

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

Phone *

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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 that take place prior, during or after soccer class. I also understand that there is an inherent risk in playing sports.

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

Cash/Check (please make sure cash/check payments are made by the early bird dates)

Zelle

Venmo

Parent Signature *

First Name

Last Name