First Name:

Last Name:

Street Address:

City:

State:

Zipcode:

Date of Birth:

Month

Day

Year

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:

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 sign and submit a participation consent form.

Click here for the Consent Form