First Name:

Last Name:

Street Address:

City:

State:

Zipcode:

Boy/Girl:

Date of Birth:

Month

Day

Year

Shirt Size:

Experience Level:

Years Playing Soccer:

Past Soccer Experience:

Describe your child:

Besides fun, whats the #1 reason your child plays?

Parent 1 First Name:

Parent 1 Last Name:

Email:

Cellphone:

Area Code

First 3 digits

Last 4 digits

Parent 2 First Name:

Parent 2 Last Name:

Email:

Cellphone:

Area Code

First 3 digits

Last 4 digits

Payment:

Teammate Request:

If your child wants to be on the same team as another player, please enter the request here. Requests can only occur for players of the same age group AND in the same package

By checking this box, I understand that I am paying membership dues for a child in this program. Membership dues are not transferable to another child or parents.

By checking this box, I understand that a child's membership can be terminated due to conduct deterimental to the program by either player or parent.

By checking this box, I understand that this payment is nonrefundable after 96 hours of making an online payment. There are no exceptions regardless of reason or circumstance. I have also read the Payment and Privacy policy.

Click here to read our policy.

By checking this box, I agree to comply with the requirements outlined in the academy program rules. I also agree to sign the Membership Agreement.

Click here to read our policy.