Clone of Spring Registration Form (New Players)

Prodigy Soccer Academy Registration
Athlete Information
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Jersey Name
Jersey Size (Ex: 12/Youth Large)
Parent/Guardian Information
Name

First NameLast Name
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number
E-mail
Preferred Language
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How did you hear about us?
If other, type here:
Emergency Contact Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
PLAYER PARTICIPATION AGREEMENT
Español
English
Signature
Payment Information
Paying in cash?
If yes, Please contact us via email or text message. prodigysocceracademy1503@gmail.com (561) 412-8492

U-3 to U6($85.00 for the first payment then,$75.00 for each month)

(Includes uniform fee)

U7-U10($90.00 for the first payment then,$80.00 for each month)

(Includes uniform fee)

U11-U17($95.00 for the first payment then,$85.00 for each month)

(Includes uniform fee)

One Day Per Week Program($60.00 for the first payment then,$50.00 for each month)

(Includes uniform fee)

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Credit Card

Cash App Pay

Prodigy Soccer Academy Registration