Summer Soccer Program Registration (Monthly Payment Plan)

Summer Soccer Program Registration (Monthly Payment Plan)
Program*
Player Information
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School
Guardian 1 Information
Name*

First NameLast Name
Relationship to student*
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Guardian 2 Information
Name

First NameLast Name
Relationship to Student
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Primary Emergency Contact
Name*

First NameLast Name
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Secondary Emergency Contact
Name*

First NameLast Name
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

How did you hear about us?*
If you are referred by someone from our club, what is his/her name?
Does the student have any allergies that we need to be aware of? If yes, please specify.*
Does the student have any other medical conditions that we need to be aware of? If yes, please specify.*
Ontario Soccer Player Waiver Form
It is mandatory for Ontario soccer players to sign after reading above Ontario Soccer Player Waiver Form
Parent Code of Conduct
Please acknowledge your agreement of Parent Code of Conduct and sign
My Products*
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Development I (Thursdays Only)
First payment: $80 6 equal payments after: $29 per month

$80.00CAD for the first payment then,$29.00CAD for each month



Development I (Sundays Only)
First payment: $80 6 equal payments after: $29 per month

$80.00CAD for the first payment then,$29.00CAD for each month



Development II (Mondays & Wednesdays)
First payment: $142 6 equal payments after: $52 per month

$142.00CAD for the first payment then,$52.00CAD for each month



Future Stars I (Thursdays Only)
First payment: $80 6 equal payments after: $29 per month

$80.00CAD for the first payment then,$29.00CAD for each month



Future Stars I (Sundays Only)
First payment: $80 6 equal payments after: $29 per month

$80.00CAD for the first payment then,$29.00CAD for each month



Future Stars II (Mondays & Wednesdays)
First payment: $142 6 equal payments after: $52 per month

$142.00CAD for the first payment then,$52.00CAD for each month



Super Girls (Thursdays Only)
First payment: $80 6 equal payments after: $29 per month

$80.00CAD for the first payment then,$29.00CAD for each month
Should be Empty:

Summer Soccer Program Registration (Monthly Payment Plan)

Player Information

Guardian 1 Information

Guardian 2 Information

Primary Emergency Contact

Secondary Emergency Contact

Ontario Soccer Player Waiver Form

Parent Code of Conduct