"*" indicates required fields Step 1 of 3 - Camper Information 33% Camper InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Select Your Camp*Northeast Regional Rec Center (Indoor) / June 16-20 / 9am - 3pm / $395Southeast Regional Rec Center / June 23-27 / 9am - 12pm / $295Honeygo Park / July 7-11 / 9am - 12pm / $295Latrobe Park / July 7-11 / 9am - 12pm / $295Carroll Indoor Sports (Carroll County) / July 14-18 / 9am - 12pm / $295Northeast Regional Rec Center (Indoor) / July 14-18 / 9am - 3pm / $395Cedar Lane Park (Harford County) / July 14-18 / 9am - 12pm / $295Monsignor Slade School / July 14-18 / 9am - 12pm / $295Meadowood Park / July 21-25 / 9am - 12pm / $295Eastern Regional Park / July 21-25 / 9am - 12pm / $295Halethorpe Community Center / July 28 - Aug 1 / 9am - 12pm / $295Southeast Regional Rec Center / July 28 - Aug 1 / 9am - 3pm / $395CCBC Dundalk (Girls Only Camp) / Aug 11-15 / 9am - 12pm / $295Cedar Lane Park (Harford County) / Aug 11-15 / 9am - 12pm / $295Northeast Regional Rec Center / Aug 18-22 / 9am - 3pm / $395Reisterstown Regional Park / Aug 18-22 / 9am - 12pm / $295T-Shirt Size*Youth SYouth MYouth LAdult SAdult MAdult LAdult XLThis camp is a Girls Only campGender* M F Other Age*Select Age Here678910111213*Blast camps are open for kids 6-13.Age*Select Age Here6789101112131415161718*Blast girls-only camps are open for kids 6-18.Add Extra T-Shirt? ($15)* Yes No Add Extra Soccer Ball? ($20)* Yes No Add a Blast Mask? ($5)* Yes No Total Billing InformationName* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent Name First Last How did you hear about our camps?Social MediaCoachesSchool FlyerPrevious CamperTerms & Waiver*Camps are non-refundable I do hereby for myself, my heirs, and assigns, waive and release any and all claims to damage against the Baltimore Blast and any camp locations and its assigns or authorized representatives conducting camp as a result of any or all injuries incurred by traveling to or from, or while participating in the camp. I give permission for my child to be photographed during camp activities. I understand these photos may be used for marketing and promotional purposes. I AgreeCecil County Waiver*I, the undersigned authorized representative of the named organization in this application, agree to abide by the rules and regulations of Cecil County Maryland and all applicable laws and agree to indemnify and save harmless the Cecil County Maryland, it’s employees and agents from any act of commission or omission which may result in any personal injury or property damage arising out of the organizations use of County facilities. I AgreeHow Do You Want To Pay?* Pay By Credit Card Now Pay By Check Pay by Payment Plan Please send non-refundable full payment to: Baltimore Blast Summer Soccer Camps, 7004 Golden Ring Road, Baltimore, MD 21237Payment plan now available for camps. We are offering a 2 payment plan. 50% due now, balance must be paid in full 2 weeks prior to the start of your scheduled camp. Please submit this form, and contact Mark Meszaros @ 443-559-0711.Coupon Processing Fee $0.00 Please note, a 5% payment processing fee is applied by our credit card processor on all purchases from The Baltimore Blast.Total Down Payment Remaining Balance $0.00 Credit Card*Card Details Cardholder Name Rather Use A Paper Form? Camps are Non-Refundable
