Parent's First Name*

Parent's Last Name*

Parent's Email*

Parent's Phone*

Player’s First Name*

Player's Last Name*

Player’s Date Of Birth:*

Month/Day/Year

Player’s Gender*Please SelectMaleFemale

Which School Does Your Child Currently Attend?*

Does Your Child Have Any Medical Conditions Coaches Should Be Aware Of?*

Zip Code Where You Live*

Program Preference*Please SelectFirst Touch - BeginnerDribble & Kick - IntermediatePass & Finish - Advanced

Has The Player Played With A Club Before?*Please SelectYesNo

Which Club Has He/She Played For?

Does This Child Have A Sibling Registered?*

Yes

No

Sibling’s Name:

Which Coach Told You About Us?

Which Friend Told You About Us?

Reference Code

How Did You Hear About Us?*Please SelectFriendSchoolSocial MediaGoogleFlyerOther

Package Selection (Select One)*

Fall 2024 Program - One Child - $250

Fall 2024 Program - Two Children - $450

Fall 2024 Program - Three Children - $600

I Acknowledge That I Have Reviewed The Club Policies*

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