Participant Information
Participant Name
*
First Name
Middle Name
Last Name
Birth Date
*
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January
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Month
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Day
Please select a year
2025
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Year
Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Player Picture
*
Passport or Birth Certificate
*
Email
example@example.com
Mobile Number
-
Area Code
Phone Number
Home Number
-
Area Code
Phone Number
School
Parent/Guardian Information
Parent/Guardian 1 Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Parent/Guardian 2 Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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Emergency Contact & Medical Information
Primary Emergency Contact Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Relationship to Player
*
Does the player have any allergies we need to be aware of?
*
Yes
No
Please describe the player's allergies
Does the player have any other medical conditions that we should know of?
Yes
No
Please describe the player's medical conditions
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Waiver
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Training Locations
Which borough are you interested in receiving training at?
Bronx
Queens
Brooklyn
Manhattan
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Organization Options
Soccer Classes
*
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( X )
Youth Private Class - Individual
$
70.00
One hour private training. It is recommended to train in groups of 4.
Quantity
1
2
3
4
5
6
7
8
9
10
Youth Private Class - Peer
$
100.00
One hour private training for 2 students at once.
Quantity
1
2
3
4
5
6
7
8
9
10
Adult Private Classes - Individual
$
70.00
One hour private training. It is recommended to train in groups of 4.
Quantity
1
2
3
4
5
6
7
8
9
10
Adult Private Classes - Peer
$
100.00
One hour private training for 2 students at once.
Quantity
1
2
3
4
5
6
7
8
9
10
Group Private Class - Small
$
120.00
One hour private training for up to 4 students at once.
Quantity
1
2
3
4
5
6
7
8
9
10
Group Private Class - Large
$
180.00
One hour private training for up to 10 students at once.
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card Details
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Last Name
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Card Expiration
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