After-School Program Registration Form:
Welcome to our registration page!Please complete the form in full to register your child for the KickSpark After-School Soccer Program.After submitting the form and payment, you will be redirected to a Thank You page where you will complete our Release & Waiver of Liability to finalize your registration.
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
-
Month
-
Day
Year
Date
Participant's Grade:
Participant's Gender
*
Male
Female
Other
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Please share anything you'd like us to know about your child (ex: sports experience, special needs, personality, etc.)
Does the participant have any allergies or medical conditions? If yes, please specify.
PAYMENT DIRECTIONS: Please submit payment via Zelle. Kindly list player's name on the memo field. Payment must be submitted to secure your child's participation in the program.
Zelle Payment Info: 510-461-3222 [Registered under Luis Ponce]
Register
Should be Empty: