Soccer Blast
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Player Information

Player's First Name *

Player's Last Name *

Birth Date * +

Age: *

3 Years Old

4 Years Old

5 Years Old

Other Other

T-Shirt Size *

Select Day: *

Thursdays

Saturdays

Thursday Sessions (6:00 PM):

Winter I - Oct 22, 29 Nov 5, 12, 19, Dec 3, 10, 17 - $90

Winter II - Jan 7, 14, 21, 28, Feb 4, 11, 18, 25 - $90

Winter III - Mar 4, 11, 18, 25, April 1, 8, 15, 22 - $90

Saturday - Sessions:

Winter I - Oct 31, Nov 7, 14, 21, 28, Dec 5, 12, 19 - $90

Winter II - Jan 2, 9, 16, 23, 30, Feb 6, 13, 20 - $90

Winter III - Feb 27, Mar 6, 13, 20, 27, April 10, 17, 24 - $90

Saturday Time: *

10:00AM - 11:00AM

11:00AM - 12:00PM

My player has a credit from Winter III 2020 to use *

Yes

No

Amount of Credit to be applied from Winter III 2020.
- This amount will be verified and any balance due will be charged.
- If your credit amount is different than listed - please contact us. *

Household / Adult Primary Contact

Parent First Name *

Parent Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Email Address *

Second Email Address/Second parent

This is to certify that I, as parent/guardian with legal responsibility for this child do consent and agree to release Soccer Blast, its officers, employees, volunteers, officials and agents from any and all claims, liabilities, loss of service and causes of action of any kind for personal injury and property damage arising out of my child’s involvement or participation in this program *

clear

Date * +

Soccer Blast TURF TOTS

Player Information

Player Information

Household / Adult Primary Contact

Soccer Blast
TURF TOTS