Individual Registration

Please enter information in the form below to process registration for our soccer event Summer Soccer Camp -2nd Week.

Username*

Password*

Retype password*

- Parent Full Name *

- Parent Email *

- Parent Phone *

- City of Residence *

- Player Full Name *

- Your Preferred Location *

- Gender *

- Date of Birth *

- Player Age Group *

- Team - Age Group *

- Jersey Size
(Jersey for player only) *

- Current School Name
(For player only) *

- Player Soccer Experience *

- How did you hear about us? *

- CAMP PREFERENCE
(Full-day or Half-day) *

Amount

Amount Deducted (-)

Total amount

Admin / Coach Code

Payment Method

Credit Card -eCheck- Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

By registering for this soccer program, I accept Terms and Conditions