Prime Moms Flag Football Clinic Registration
Learn the game. Join the fun. Sunday, September 20, 4:00–6:00 PM at Prime Time Fitness – Southland Mall, 5953 West Park Avenue, Houma. Registration is $40 and includes an exclusive Prime Moms shirt. Only 24 spots are available. No experience needed.
Participant Information
Participant Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Middle Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
T-Shirt Size
*
Please Select
XS
S
M
L
XL
XXL
Payment and Acknowledgments
I understand and agree to pay the $40 registration fee, which includes an exclusive Prime Moms shirt.
*
I understand and agree to pay the $40 registration fee, which includes an exclusive Prime Moms shirt.
Registration Fee
*
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Prime Moms Flag Football Clinic Registration
Registration fee includes an exclusive Prime Moms shirt.
$40.00
$
40.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
I authorize Square payment processing for my registration fee.
*
I authorize Square payment processing for my registration fee.
Liability Waiver
Liability Waiver
*
Agreement
*
I have read and agree to the Liability Waiver and understand that participation in the Prime Moms Flag Football Clinic involves physical activity and inherent risks and will not hold Prime Time Fitness liable for any injury or ailments that may arise as a result of my participation.
Electronic Signature
*
Register
Register
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