J Dream Soccer Challenge in Orlando 2019 申込みフォーム (Application Form)
[イベント詳細 / Event info]
Please note this event is a soccer school conducted primarily in Japanese by Japanese professional athletes. However, we can accommodate children who speak only English.

日時 (Date and time):
Sunday, December 15, 2019
1pm-3pm; 4pm-6pm
(Children will be divided into 2 groups based on age)

元日本代表   山田卓也 コーチ (Takuya Yamada)
元清水エスパルス/柏レイソル 太田圭輔 コーチ (Keisuke Ota)
元なでしこジャパン日本代表  山口麻美 コーチ (Mami Yamaguchi)
会場 (Location):
Free Kick Orlando (インドアサッカー場 / Indoor Soccer Field)
3180 Southgate Commerce Blvd
Orlando, FL 32806

参加料金 (Cost):$20 / お子様 (per child)
当日現金にて (We accept cash only on the day of the event)

Parents, if you have more than one child, please fill out a separate form for each child.

お問い合わせは、j.dream.soccer.challenge.mco@gmail.com までご連絡いただきますようお願い致します。
If you have any questions, please feel free to contact us by email at j.dream.soccer.challenge.mco@gmail.com

Sponsored and supported by: Mitsubishi Hitachi Power Systems Americas, IACE Travel, mickeynet, True World Foods, Mitsukoshi U.S.A., JFC International, Wismettac Asian Foods, Kirin, Sapporo, Sapporo Ramen
お子様の氏名 (Child's full name) *
Your answer
Your answer
お子様の年齢 (Child's age) *
お子様の性別 (Child's gender) *
保護者の氏名 (Full name of parent/legal guardian) *
Your answer
Your answer
電話番号 (Emergency contact phone number) *
Your answer
サッカー経験年数 (Child's amount of soccer experience - months/years) *
Your answer
メールアドレス (Email address) *
Your answer
Language preference for email *
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