First Name:

Last Name:

Street Address:

City:

State:

Zipcode:

Boy/Girl:

Date of Birth:

Month

Day

Year

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:

Membership Start:

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.

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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.

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