Family Discount - Rebate Request Form
This rebate is only available to those families that have three (3) or more children playing in the same program in the same season with Pickering FC.
Parent/Guardian Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Todays Date
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Original Payment by:
*
Online - Sportsengine
In Office - Cash/Check
In Office - Debit/Credit
Player Information
*
Rows
Date of Birth
Gender
Program
(ie. Rec, Comp, OPDL, AA)
Age Group
(ie. U4 , U10, U17)
Child #1
Male
Female
Child #2
Male
Female
Child #3
Male
Female
If you have more than 3 children please type info below
Signature
*
Submit
Should be Empty: