Name of Parent/Guardian
*
First Name of Parent/Guardian
Last Name of Parent/Guardian
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Name of Participant
*
First Name of Participant
Last Name of Participant
Age of Participant
*
Participant may be photographed/video graphed during the Soccer Classes at India House and these pictures/videos may be used on India House website/social media for outreach purposes.
Signature
*
Register
Register
Should be Empty: