subject_line
Soccer Blast
TURF TOTS
Player Information
Player Information
Player's First Name
*
Player's Last Name
*
Birth Date
*
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Age:
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3 Years Old
4 Years Old
5 Years Old
Other
Other
T-Shirt Size
*
Youth 2/4 (XS)
Youth 6/8 (S)
Youth 10/12 (M)
Youth 14/16 (L)
Adult Small
Other
Other
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.
*
$56.25
Household / Adult Primary Contact
Parent First Name
*
Parent Last Name
*
Address 1
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Address 2
City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip
*
Phone
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Email Address
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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
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clear
Date
*
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