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Submission Tags: falconsandbox
Submission: On May 16 via api from US — Scanned from DE
Submission Tags: falconsandbox
Submission: On May 16 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
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<ul>
<li><a class="active"><span>STEP ONE</span><br>ENTER INFO</a></li>
<li><a><span>STEP TWO</span><br>CONFIRMATION</a></li>
<li><a><span>STEP THREE</span><br>RECEIPT</a></li>
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<div align="center"><span style="font-size: 17px; font-weight: bold;">TLU Men’s Soccer College Prep Camp 2023</span><br><br><span style="font-size: 17px; font-weight: bold;">Friday, July 7th - Sunday July 9th<br>Gustafson Soccer Field on
Texas Lutheran University's campus<br><br>Eddie Salazar - Camp Director and Men's Soccer Coach<br>George Kee - Men's Soccer Assistant Coach</span></div>
</div>
<div id="section-26" data-section-link-id="26" class="section editable pgraph">
<p>Our college prep camp is a physically demanding and informative camp that educates the player about the real experiences for top players at the college level. Current college coaches from a variety of universities will be on staff.</p>
<p>Due to the success of our Parent Breakout Session during our ID Camp, we are responding to the requests of the parents and we will have another Parent Breakout Session as part of our College Prep Camp. The feedback has been positive
regarding the information received and we will meet the demands of what the parents want to experience. This session will take place just after all campers get checked in on Friday July 7th.</p>
<p>On field and classroom sessions are directed by the TLU coaching staff and cover activities we regularly use with our players. Campers are assigned to camp teams based on age and ability with adjustments made as needed.</p>
<p>Our goal is to provide an exact replica of what the athlete experience entails. Our campers will stay in the freshmen dorms, eat all meals in the dining hall, participate in a college talk, and train on our field while being supervised by
our certified Athletic Trainer on staff.</p>
<p>In addition, each camper will receive two full training kits that will be required to wear at each training session throughout the camp. This initiative will promote time management skills, discipline in the locker room, and familiarity of
the campus.</p>
<p><strong>Itinerary</strong></p>
<div>
<div>
<p>July 7</p>
</div>
<div>
<p>1pm Camper check-in</p>
</div>
<div>
<p>2:30pm Parent Breakout Session/Field activities</p>
</div>
<div>
<p>5pm Dinner in Hein Dining Hall</p>
</div>
<div>
<p>8pm Field activities</p>
<p> </p>
</div>
<div>
<p>July 8</p>
</div>
<div>
<p><em>Continental breakfast in dorm</em></p>
</div>
<div>
<p>9am Field activities</p>
</div>
<div>
<p>11:30am Lunch in Hein Dining Hall</p>
</div>
<div>
<p>2:30pm Field activities</p>
</div>
<div>
<p>5pm Dinner in Hein Dining Hall</p>
</div>
<div>
<p>8pm Field activities </p>
</div>
<div>
<p> </p>
</div>
<div>
<p>July 9</p>
</div>
<div>
<p><em>Continental breakfast in dorm</em></p>
</div>
<div>
<p>9am Field activities</p>
</div>
<div>
<p>12pm Campers check out of dorms</p>
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<span style="line-height: 150%;">Total:</span>
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<span>Future Commitment: </span>
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<div id="field-56" data-field-link-id="56" class="fieldrow editable heading group0 set0">Participant Information</div>
<div id="field-164" data-field-link-id="164" class="fieldrow editable pgraph group0 set0"><span style="font-weight: 600; color: #ff0000;"><u>PRINTABLE WAIVER</u>:</span>
<b>Please <a href="https://my.tlu.edu/ICS/icsfs/IDcampWaiver.pdf?target=06c55f6b-c394-4f6a-87fb-530f31abd441" target="_blank">CLICK HERE</a> to print your Waiver and bring with you.</b></div>
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<div class="label"><label for="studentfirstname">First Name:<span class="required"> *</span></label></div>
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<div class="label"><label for="studentlastname">Last Name:<span class="required"> *</span></label></div>
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<div class="label"><label for="student1dob">Date of Birth:<span class="required"> *</span></label></div>
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<div class="label"><label for="studentphone">Phone:<span class="required"> *</span></label></div>
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<div class="label"><label for="part2firstname">First Name:<span class="required"> *</span></label></div>
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<div class="label"><label for="part2dob">Date of Birth:<span class="required"> *</span></label></div>
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</div>
<div id="field-169" data-field-link-id="169" class="fieldrow editable group1 set1" style="display: none;">
<div class="label"><label for="part2phone">Phone:<span class="required"> *</span></label></div>
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<div class="label"><label for="part2tshirtsize">T-Shirt Size:<span class="required"> *</span></label></div>
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<div class="label"><label for="part2gradyear">Graduation Year:<span class="required"> *</span></label></div>
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<div class="label"><label for="position_2">Position<span class="required"> *</span></label></div>
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<option value="" selected="">-- Select An Option --</option>
<option value="Goalkeeper">Goalkeeper</option>
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<option value="Forward">Forward</option>
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<div id="field-188" data-field-link-id="188" class="fieldrow editable group1 set1" style="display: none;">
<div class="label"><label for="part2academicinterest">Academic Interest:<span class="required"> *</span></label></div>
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</div>
<div id="field-194" data-field-link-id="194" class="fieldrow editable group1 set1" style="display: none;">
<div class="label"><label for="camperemail2">Camper Email:<span class="required"> *</span></label></div>
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<div class="aligncenter" style="width:100% ;height:0;border-top:3px solid #000000;"></div>
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<div class="label"><label for="part3firstname">First Name:<span class="required"> *</span></label></div>
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<div class="label"><label for="part3lastname">Last Name:<span class="required"> *</span></label></div>
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<div class="label"><label for="part3dob">Date of Birth:<span class="required"> *</span></label></div>
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<div class="label"><label for="part3academicinterest">Academic Interest:<span class="required"> *</span></label></div>
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<div id="field-195" data-field-link-id="195" class="fieldrow editable group1 set2" style="display: none;">
<div class="label"><label for="camperemail3">Camper Email:<span class="required"> *</span></label></div>
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<div class="label"><label for="part4firstname">First Name:<span class="required"> *</span></label></div>
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</div>
<div id="field-179" data-field-link-id="179" class="fieldrow editable group1 set3" style="display: none;">
<div class="label"><label for="part4lastname">Last Name:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="part4lastname" name="part4lastname" value="" class="form-control required-if-shown"></div>
</div>
<div id="field-180" data-field-link-id="180" class="fieldrow editable group1 set3" style="display: none;">
<div class="label"><label for="part4dob">Date of Birth:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="part4dob" name="part4dob" value="" class="form-control required-if-shown"></div>
</div>
<div id="field-181" data-field-link-id="181" class="fieldrow editable group1 set3" style="display: none;">
<div class="label"><label for="part4phone">Phone:<span class="required"> *</span></label></div>
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<div class="label"><label for="part4tshirtsize">T-Shirt Size:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="part4tshirtsize" name="part4tshirtsize" value="" class="form-control required-if-shown"></div>
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<div id="field-126" data-field-link-id="126" class="fieldrow editable group1 set3" style="display: none;">
<div class="label"><label for="studentschool4">Current College/<br>High School:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="studentschool4" name="studentschool4" value="" class="form-control required-if-shown"></div>
</div>
<div id="field-191" data-field-link-id="191" class="fieldrow editable group1 set3" style="display: none;">
<div class="label"><label for="part4gradyear">Graduation Year:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="part4gradyear" name="part4gradyear" value="" class="form-control required-if-shown"></div>
</div>
<div id="field-200" data-field-link-id="200" class="fieldrow editable group1 set3" style="display: none;">
<div class="label"><label for="position_4">Position<span class="required"> *</span></label></div>
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<option value="Goalkeeper">Goalkeeper</option>
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<div class="label"><label for="part4academicinterest">Academic Interest:<span class="required"> *</span></label></div>
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<div class="label"><label for="camperemail4">Camper Email:<span class="required"> *</span></label></div>
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<div id="field-156" data-field-link-id="156" class="fieldrow editable group0 set0">
<div class="label"><label for="parentguardian">Parent/Guardian:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="parentguardian" name="parentguardian" value="" class="form-control required-if-shown required"></div>
</div>
</div>
</fieldset>
<fieldset>
<div class="fieldsetinside">
<div id="field-157" data-field-link-id="157" class="fieldrow editable heading group0 set0">EMERGENCY CONTACT INFORMATION</div>
<div id="field-163" data-field-link-id="163" class="fieldrow editable pgraph group0 set0"><b>Insurance:</b> Parents/Guardians are responsible for providing proof of insurance.</div>
<div id="field-158" data-field-link-id="158" class="fieldrow editable group0 set0">
<div class="label"><label for="emergencycontact">Emergency Contact Name:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="emergencycontact" name="emergencycontact" value="" class="form-control required-if-shown required"></div>
</div>
<div id="field-159" data-field-link-id="159" class="fieldrow editable group0 set0">
<div class="label"><label for="emergencyphone">Emergency Contact Phone:<span class="required"> *</span></label></div>
<div class="input"><input type="tel" id="emergencyphone" name="emergencyphone" value="" onkeypress="prevent_nonphone_input(event)" class="form-control required-if-shown required windows1252"></div>
</div>
<div id="field-160" data-field-link-id="160" class="fieldrow editable group0 set0">
<div class="label"><label for="emergencyemail">Emergency Email:</label></div>
<div class="input"><input type="email" id="emergencyemail" name="emergencyemail" value="" class="form-control format_email windows1252"></div>
</div>
<div id="field-161" data-field-link-id="161" class="fieldrow editable group0 set0">
<div class="label"><label for="physician">Physician’s Name:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="physician" name="physician" value="" class="form-control required-if-shown required"></div>
</div>
<div id="field-162" data-field-link-id="162" class="fieldrow editable group0 set0">
<div class="label"><label for="policyidnumber">Policy ID Number:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="policyidnumber" name="policyidnumber" value="" class="form-control required-if-shown required"></div>
</div>
</div>
</fieldset>
<fieldset class="default-field">
<div class="fieldsetinside">
<div id="field-54" data-field-link-id="54" class="fieldrow editable heading group0 set0">Payer Information</div>
<div id="field-21" data-field-link-id="21" class="fieldrow editable group0 set0">
<div class="label"><label for="payer_fname">First Name:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="payer_fname" name="payer_fname" value="" maxlength="30" class="form-control default-field required-if-shown required payer windows1252"></div>
</div>
<div id="field-22" data-field-link-id="22" class="fieldrow editable group0 set0">
<div class="label"><label for="payer_lname">Last Name:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="payer_lname" name="payer_lname" value="" maxlength="35" class="form-control default-field required-if-shown required payer windows1252"></div>
</div>
<div id="field-23" data-field-link-id="23" class="fieldrow editable group0 set0">
<div class="label"><label for="billing_address">Billing Address:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="billing_address" name="billing_address" value="" maxlength="32" class="form-control default-field required-if-shown required payer windows1252"><span class="comment">This is the address where your
credit card statements are mailed.</span></div>
</div>
<div id="field-24" data-field-link-id="24" class="fieldrow editable group0 set0">
<div class="label"><label for="billing_address2">Address 2:</label></div>
<div class="input"><input type="text" id="billing_address2" name="billing_address2" value="" maxlength="32" class="form-control default-field payer windows1252"></div>
</div>
<div id="field-25" data-field-link-id="25" class="fieldrow editable group0 set0">
<div class="label"><label for="billing_city">City:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="billing_city" name="billing_city" value="" maxlength="32" class="form-control default-field required-if-shown required payer windows1252"></div>
</div>
<div id="field-26" data-field-link-id="26" class="fieldrow editable group0 set0">
<div class="label"><label for="billing_state">State / Province:</label></div>
<div class="input"><input type="text" id="billing_state" name="billing_state" value="" class="windows1252 form-control default-field required-if-shown"></div>
</div>
<div id="field-27" data-field-link-id="27" class="fieldrow editable group0 set0">
<div class="label"><label for="billing_zip">Zip Code:</label></div>
<div class="input"><input type="text" id="billing_zip" name="billing_zip" value="" maxlength="10" class="form-control default-field required-if-shown payer windows1252"></div>
</div>
<div id="field-28" data-field-link-id="28" class="fieldrow editable group0 set0">
<div class="label"><label for="billing_country">Country:<span class="required"> *</span></label></div>
<div class="input"><select id="billing_country" name="billing_country" class="form-control default-field required-if-shown required payer" onchange="change_country(this)">
<option value="">-- Select An Option --</option>
<option value="USA">United States of America</option>
<option value="CAN">Canada</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Aland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="ASM">American Samoa</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua & Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia</option>
<option value="BES">Bonaire, Saint Eustatius and Saba</option>
<option value="BIH">Bosnia & Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island (Bouvetoya)</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="VGB">British Virgin Islands</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CPV">Cape Verde</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COD">Democratic Republic of Congo</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Cote D'Ivoire & Ivory Coast</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curacao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FRO">Faeroe Islands</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon & Gabonese Republic</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU" selected="">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece & Hellenic Republic</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadaloupe</option>
<option value="GGY">Guernsey</option>
<option value="GUM">Guam</option>
<option value="GTM">Guatemala</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard & McDonald Islands</option>
<option value="VAT">Holy See (Vatican City State)</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HRV">Croatia</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Democratic People's Republic of Korea</option>
<option value="KOR">Republic of Korea</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyz Republic</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon & Lebanese Republic</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libyan Arab Jamahiriya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MKD">Macedonia</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia</option>
<option value="MDA">Moldova</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="ANT">Netherlands Antilles</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MNP">Northern Mariana Islands</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn Island</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="PRI">Puerto Rico</option>
<option value="QAT">Qatar</option>
<option value="COG">Republic of Congo</option>
<option value="REU">Reunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">St. Barthelemy</option>
<option value="SHN">St. Helena</option>
<option value="KNA">St. Kitts & Nevis</option>
<option value="LCA">St. Lucia</option>
<option value="MAF">St. Martin</option>
<option value="SPM">St. Pierre & Miquelon</option>
<option value="VCT">St. Vincent & the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome & Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SCG">Serbia & Montenegro</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia & South Sandwich Islands</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SSD">South Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard & Jan Mayen Islands</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo & Togolese Republic</option>
<option value="TKL">Tokelau (Tokelau Islands)</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad & Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks & Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom of Great Britain & N. Ireland</option>
<option value="UMI">United States Minor Outlying Islands</option>
<option value="VIR">United States Virgin Islands</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela</option>
<option value="VNM">Viet Nam</option>
<option value="WLF">Wallis & Futuna Islands</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</select></div>
</div>
<div id="field-50" data-field-link-id="50" class="fieldrow editable group0 set0">
<div class="label"><label for="payer_phone">Telephone:</label></div>
<div class="input"><input type="tel" id="payer_phone" name="payer_phone" value="" onkeypress="prevent_nonphone_input(event)" maxlength="32" class="form-control default-field payer windows1252"></div>
</div>
<div id="field-29" data-field-link-id="29" class="fieldrow editable group0 set0">
<div class="label"><label for="payer_email">E-mail:<span class="required"> *</span></label></div>
<div class="input"><input type="email" id="payer_email" name="payer_email" value="" class="form-control default-field required-if-shown required payer format_email windows1252"><span class="comment">A receipt will be e-mailed to this
address.</span></div>
</div>
</div>
</fieldset>
<fieldset>
<div class="fieldsetinside">
<div id="field-40" data-field-link-id="40" class="fieldrow editable heading group0 set0" style="border-bottom: 0px;">Your Payment Information</div>
<div id="payment-modes" class="ui-accordion ui-widget ui-helper-reset" role="tablist">
<h3 id="payment_panel_1" data-payment-mode="1" class="payment-panel ui-accordion-header ui-corner-top ui-state-default ui-accordion-header-active ui-state-active" role="tab" aria-controls="ui-id-1" aria-selected="true" aria-expanded="true"
tabindex="0">
<div class="payment-option-radio"></div>
<div class="payment-option-icon-group"><img id="payment-type-visa" src="assets/img/payment_types/visa.svg" alt="Visa" title="Visa" class="payment-option-icon"><img id="payment-type-mastercard" src="assets/img/payment_types/mastercard.svg"
alt="MasterCard" title="MasterCard" class="payment-option-icon"><img id="payment-type-amex" src="assets/img/payment_types/amex.svg" alt="American Express" title="American Express" class="payment-option-icon"><img
id="payment-type-discover" src="assets/img/payment_types/discover.svg" alt="Discover" title="Discover" class="payment-option-icon"><img id="payment-type-jcb" src="assets/img/payment_types/jcb.svg" alt="JCB" title="JCB"
class="payment-option-icon"></div>
</h3>
<div class="ui-accordion-content ui-corner-bottom ui-helper-reset ui-widget-content ui-accordion-content-active" id="ui-id-1" aria-labelledby="payment_panel_1" role="tabpanel" aria-hidden="false" style="">
<div class="fieldrow payfieldrow">
<div class="label"><label for="cc_acct_name">Name on Card:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="cc_acct_name" name="cc_acct_name" value="" class="windows1252 form-control" maxlength="64" style="width: 50%;"></div>
</div>
<div class="fieldrow payfieldrow">
<div class="label"><label for="cc_num">Card Number:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="cc_num" name="cc_num" value="" class="windows1252 form-control" maxlength="25" style="width: 50%;" autocomplete="off"></div>
</div>
<div class="fieldrow payfieldrow">
<div class="label"><label for="cc_cvv">Security Code:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="cc_cvv" name="cc_cvv" value="" class="windows1252 form-control" maxlength="4" style="width: 20%;"></div>
</div>
<div class="fieldrow payfieldrow">
<div class="label"><label>Expiration Date:<span class="required"> *</span></label></div>
<div class="input"><select id="cc_exp_mo" name="cc_exp_mo" class="form-control" style="display: inline; margin-right: 5px; width: 50px;">
<option value="" selected="">Mo</option>
<option value="01">1</option>
<option value="02">2</option>
<option value="03">3</option>
<option value="04">4</option>
<option value="05">5</option>
<option value="06">6</option>
<option value="07">7</option>
<option value="08">8</option>
<option value="09">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select><select id="cc_exp_yr" name="cc_exp_yr" class="form-control" style="display: inline; width: 80px;">
<option value="" selected="">Year</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
</select></div>
</div>
</div>
<h3 id="payment_panel_2" data-payment-mode="2" class="payment-panel ui-accordion-header ui-corner-top ui-accordion-header-collapsed ui-corner-all ui-state-default" role="tab" aria-controls="ui-id-2" aria-selected="false" aria-expanded="false"
tabindex="-1">
<div class="payment-option-radio"></div>
<div class="payment-option-icon-group"><img id="payment-type-echeck" src="assets/img/payment_types/echeck.gif" alt="eCheck" title="eCheck" class="payment-option-icon"></div>
</h3>
<div class="ui-accordion-content ui-corner-bottom ui-helper-reset ui-widget-content" id="ui-id-2" aria-labelledby="payment_panel_2" role="tabpanel" aria-hidden="true" style="display: none;">
<div class="fieldrow payfieldrow">
<div class="label"><label for="ach_acct_name">Name on Account:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="ach_acct_name" name="ach_acct_name" value="" class="windows1252 form-control" maxlength="64" style="width: 50%;"></div>
</div>
<div class="fieldrow payfieldrow">
<div class="label"><label for="ach_routing_num">Routing Number:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="ach_routing_num" name="ach_routing_num" value="" class="windows1252 form-control" maxlength="9" style="width: 50%;"></div>
</div>
<div class="fieldrow payfieldrow">
<div class="label"><label for="ach_acct_num">Account Number:<span class="required"> *</span></label></div>
<div class="input"><input type="text" id="ach_acct_num" name="ach_acct_num" value="" class="windows1252 form-control" maxlength="25" style="width: 50%;"></div>
</div>
</div>
</div>
<div id="grecaptcha" name="grecaptcha" class="form-group">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6Lc-EsMSAAAAAAydmjZhBbRY2SXrFqzEaDOG-yI1&co=aHR0cHM6Ly9zZWN1cmUuYWNjZXB0aXZhLmNvbTo0NDM.&hl=de&v=wqcyhEwminqmAoT8QO_BkXCr&size=normal&cb=xnouvlyrxtzy"
width="304" height="78" role="presentation" name="a-3rn3ow8xu3z" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
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Looks like you're using Safari! To complete your transaction you'll need to open the form in a new tab. Click the button below to continue. * STEP ONE ENTER INFO * STEP TWO CONFIRMATION * STEP THREE RECEIPT TLU Men’s Soccer College Prep Camp 2023 Friday, July 7th - Sunday July 9th Gustafson Soccer Field on Texas Lutheran University's campus Eddie Salazar - Camp Director and Men's Soccer Coach George Kee - Men's Soccer Assistant Coach Our college prep camp is a physically demanding and informative camp that educates the player about the real experiences for top players at the college level. Current college coaches from a variety of universities will be on staff. Due to the success of our Parent Breakout Session during our ID Camp, we are responding to the requests of the parents and we will have another Parent Breakout Session as part of our College Prep Camp. The feedback has been positive regarding the information received and we will meet the demands of what the parents want to experience. This session will take place just after all campers get checked in on Friday July 7th. On field and classroom sessions are directed by the TLU coaching staff and cover activities we regularly use with our players. Campers are assigned to camp teams based on age and ability with adjustments made as needed. Our goal is to provide an exact replica of what the athlete experience entails. Our campers will stay in the freshmen dorms, eat all meals in the dining hall, participate in a college talk, and train on our field while being supervised by our certified Athletic Trainer on staff. In addition, each camper will receive two full training kits that will be required to wear at each training session throughout the camp. This initiative will promote time management skills, discipline in the locker room, and familiarity of the campus. Itinerary July 7 1pm Camper check-in 2:30pm Parent Breakout Session/Field activities 5pm Dinner in Hein Dining Hall 8pm Field activities July 8 Continental breakfast in dorm 9am Field activities 11:30am Lunch in Hein Dining Hall 2:30pm Field activities 5pm Dinner in Hein Dining Hall 8pm Field activities July 9 Continental breakfast in dorm 9am Field activities 12pm Campers check out of dorms Registrations Qty Description Amount Total 1234 Participants Fee $500.00 $500.00 Discount Code --- Total: $500.00 Future Commitment: $0.00 Participant Information PRINTABLE WAIVER: Please CLICK HERE to print your Waiver and bring with you. First Name: * Last Name: * Date of Birth: * Phone: * T-Shirt Size: * Current College/ High School: * Graduation Year: * Position * -- Select An Option --GoalkeeperDefenderMidfielderForwardUtility Academic Interest: * Camper Email: * First Name: * Last Name: * Date of Birth: * Phone: * T-Shirt Size: * Current College/ High School: * Graduation Year: * Position * -- Select An Option --GoalkeeperDefenderMidfielderForwardUtility Academic Interest: * Camper Email: * First Name: * Last Name: * Date of Birth: * Phone: * T-Shirt Size: * Current College/ High School: * Graduation Year: * Position * -- Select An Option --GoalkeeperDefenderMidfielderForwardUtility Academic Interest: * Camper Email: * First Name: * Last Name: * Date of Birth: * Phone: * T-Shirt Size: * Current College/ High School: * Graduation Year: * Position * -- Select An Option --GoalkeeperDefenderMidfielderForwardUtility Academic Interest: * Camper Email: * Parent/Guardian: * EMERGENCY CONTACT INFORMATION Insurance: Parents/Guardians are responsible for providing proof of insurance. 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