Moon Soccer Skills Clinic Registration
To submit $75 payment, choose one of these options:
- Using Paypal, send payment to Christopher A Lantzy or use the email address calantzy@hotmail.com
- Mail a check to: Chris Lantzy, 511 Arthur Dr, Moon Township, PA 15108
Email address *
Child's name *
Your answer
Gender *
Birth date *
Your answer
Number of seasons of soccer played *
Your answer
Parent(s) Name *
Your answer
Address *
Your answer
Phone number *
Your answer
List any allergies that your child has *
Your answer
Emergency Contact and phone number *
Your answer
Would you be interested in private 1 on 1 or small group training? *
A copy of your responses will be emailed to the address you provided.
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