REGISTRATION Child Information First Name Last Name Date of Birth Gender Please Select Female Male Age Please Select 3-12 months 12-18 months 18-24 months 2-4 years old School Attending Parent Information Mother Name Father Name Address City/State/Zip Phone Email Registration Please select Sessions or number of Single Classes: Super Soccer Stars Wednesdays 2-4 years old Session 1 | $420 | 9/30-12/23 Session 2 | $390 | 1/6-3/30 Session 3 | $210 | 4/13-6/8 Single Classes ($35/class): 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Payment Total Amount Card Type Please Select Visa Mastercard American Express Card Number Expiration Date CVV Code Comments
