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Ada Merritt After-school Soccer Program - Fall 2014
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* Indicates required question
Program runs from August 26th- December 18TH
Cost includes soccer lessons, a training t shirt and a end of season trophy.
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Male or Female
*
male
female
Required
D.O.B
*
MM
/
DD
/
YYYY
School Grade
*
From August 2014
Your answer
Does your child have any allergies or conditions that Cyclone staff should be aware of?
If the answer is YES, please give us more information
Your answer
Grade & Classroom #
*
If unsure, please enter teachers name
Your answer
After care classroom #
*
Choose
No, I will pick up directly from the field
Yes, please return him to after-care
How many sessions per week would you like your child to attend? *
*
3 x per week ($480)
2 x per week ($380)
1 x per week ($230)
Which days would you like your child to participate on?
*
Multiple choice. Check the correct DAY, GRADE and TIME.
Tuesday (PK-1st Grade 2-3pm)
Tuesday (2-6 Grade 3-4pm)
Tuesday (IS program students 4.15-5.15pm)
Wednesday (All grades 2-3pm)
Thursday (PK-1st Grade 2-3pm)
Thursday (2-6 Grade 3-4pm)
Thursday (IS program students 4.15-5.15pm)
All 3 sessions (PK-1st Grade)
All 3 sessions (2-6 Grade 3-4pm)
All 3 sessions (IS program students 4.15-5.15pm)
Required
Mother First and last Name
*
Your answer
Father FIrst and Last Name
*
Your answer
Street Address
*
include house/apartment #
Your answer
City/Town
*
Your answer
Zip Code
*
Your answer
Telephone Number #1
*
use a number where you can be easily reached
Your answer
Telephone Number #2
*
use a number where you can be easily reached
Your answer
E-mail address
*
Your answer
Other e-mail address
*
perhaps a wife/husband, guardian, grandparent or nanny
Your answer
Emergency Contact Number
*
If we need to contact a responsible asap
Your answer
I have read, understand and agree with the terms and conditions related to my childs enrollment in Cyclone soccer Inc soccer programs
*
If your answer is no, it is your responsibilty to contact Cyclone staff
Choose
YES
NO
Form of Payment
*
Check to be left in Cyclone Mail Box, located in school office
Cash (Contact Cyclone Soccer Staff)
Credit/Debit card. Square Program (complete bellow)
Credit/debit card information FULL NAME
*
or n/a
Your answer
Credit/debit card information Card #
*
or n/a
Your answer
Credit/debit card information: Expiration date : mm/yy
*
or n/a
Your answer
Credit/debit card information Security Code
*
or n/a
Your answer
Credit/debit card information Zip Code
*
or n/a
Your answer
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