Little Kickers

Little Kickers Program

Wednesday 5-6pm, $84. Ages 4-6. Tamien Park
Join Healing Grove Sports Little Kickers soccer program.

Wednesday 5-6pm August 28th to Oct 9th.

Tamien Park, 1135 Lick Ave San Jose Ca 95110

Camp cost is ${costPer} per player per week for ages 4-6 years old.

Contact:
Coach Noe Guzman
(669) 800-5782 (call or text)
noe@healinggrove.org
Parent Name*

First NameLast Name
Parent Phone *
Please enter a valid phone number.
Parent Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address
Camp Cost

$125/Week/Player
Number of players you will register*
Player #1

Enter the information below for your child
#1: Player Name*

First NameLast Name
#1: Player Birthdate*

MonthDayYear
#1: Player Phone Number (optional)
{1Player}'s camp selections
Player #1 Total Weeks
Player #2

Enter the information below for your child
#2: Player Name*

First NameLast Name
#2: Player Birthdate*

MonthDayYear
#2: Player Phone Number (optional)
{2Player}'s camp selections
Player #2 Total Weeks
Player #3

Enter the information below for your child
#3: Player Name*

First NameLast Name
#3: Player Birthdate*

MonthDayYear
#3: Player Phone Number (optional)
{3Player}'s camp selections
Player #3 Total Weeks
Cost per player per week
Total Fee
USD
Total Fee After Coupon
USD
Payment Information
Coupon Code

Total Fee

USDTotal Fee

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

HEALING GROVE SPORTS WAIVER AND RELEASE OF LIABILITY

Healing Grove Sports RENUNCIA Y LIBERACIÓN DE RESPONSABILIDAD
I agree to the waiver as stated above. Additionally, I agree to electronic signature indicating my acceptance of above stated waiver and hold harmless.*

I accept and agree to waiver and hold harmless as stated above and to electronic signature
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