Wasp Soccer Academy Registration Form

To register for the Wasp Soccer Academy, please fill out the following form. The information will reach Head Coach Nathan Kish and he will be in touch with you shortly after submission.

Please call Coach Kish at 276-944-6699 or email at nkish@ehc.edu with any questions.  

Please send in a check for $100 ($80 if registering with a team of 5 or more) made payable to Emory & Henry College. Please write "Men's Soccer" on the memo line.

Send payment to:

Emory & Henry College
King Center
Nathan Kish
P.O. Box 947
Emory, VA 24327


Player First Name:
Player Last Name:
Gender:
Date of Birth:
Age:
Grade (fall 2012):
Address:
City:
State:
Zip:
School:
Club Team:
Parent/Guardian Name:
Home Phone:
Parent/Guardian Cell Phone:
Parent/Guardian Email:
If attending camp as a team/group, team name:
T-Shirt Size: