REGISTER FOR OUR AFTERSCHOOL LEADERSHIP & SPORTS PROGRAM

REGISTER FOR OUR AFTERSCHOOL PROGRAM
PLEASE SELECT LOCATION

SOCCER ZONE SOUTH
PRIMARY GUARDIAN*

First NameLast Name
PRIMARY GUARDIAN'S EMAIL*
PRIMARY GUARDIAN'S PHONE*
SECONDARY GUARDIAN

First NameLast Name
SECONDARY GUARDIAN'S EMAIL
SECONDARY GUARDIAN'S PHONE
CHILD'S NAME*

First NameLast Name
PLEASE UPLOAD CHILD'S PHOTO

Upload a File

Cancelof
DATE OF BIRTH*
GRADE*
SCHOOL*
TEACHER'S NAME
SHIRT SIZE*
MAIN ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
DAY(S) PLANNING ON ATTENDING?*

MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAY
WOULD YOU LIKE PICKUP SERVICE?*

YESNO
DESCRIBE CHILD'S ATHLETICISM*

EXTREMELY ATHLETICGOODAVERAGENOT ATHLETIC
CHILD'S ORGANIZED SPORT(S)*

SOCCERFOOTBALLBASKETBALLBASEBALL/SOFTBALLTRACK & FIELDVOLLEYBALL
HOW DID YOU HEAR ABOUT US?*
PREFERRED METHOD OF PAYMENT*

CREDIT CARDCHECKCASH
BILLING EMAIL ADDRESS*

PAYMENT OPTIONS*

YEARLY REGISTRATION + MEMBERSHIP FEE$75.00

RESERVATION FEE FOR FOOTWORK + FINISHING TRAINING$40.00

monthly fee for 45 minute speed and agility session once a week.

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

REGISTER FOR OUR AFTERSCHOOL PROGRAM