Futsal Registration (due by Oct. 24th)
Session dates: Nov 1 - Dec 20 (includes 6 games & 1 tournament)
Questions? Please contact Justin Rothshank
jrothshank@gmail.com
Parent's Name:
*
First Name
Last Name
Parent's Phone Number:
*
Please enter a valid phone number.
Parent's Email:
*
example@example.com
Are you willing to help coach a team?
*
Please Select
Yes
No
How many students are you registering?
*
Please Select
1
2
3
Student 1
Student 1 Name:
First Name
Last Name
Student 1 Birthdate:
-
Month
-
Day
Year
Date
Student 1 Current Grade:
Student 2
Student 2 Name:
First Name
Last Name
Student 2 Birthdate:
-
Month
-
Day
Year
Date
Student 2 Current Grade:
Student 3
Student 3 Name:
First Name
Last Name
Student 3 Birthdate:
-
Month
-
Day
Year
Date
Student 3 Current Grade:
Registration/Payment
Registration fee
*
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Registration fee
Cost per player
$
80.00
Quantity
1
2
3
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Buy with
Buy with
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