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Futsal Xmas Break Camp, Dec 27-29, 2016 Online Registration Form

Please fill out the form on this page very carefully. Once the form is submitted correctly, 
you will be taken to a secure payment page where you will be able to take care of payment via PayPal or a credit card.
The online payment includes a processing fee.

ALL FIELDS ARE REQUIRED

 


Parent Name:



Parent Email:


Parent Telephone:


Please select phone type:

 Home Work Mobile


Participant's Name:


Participant's DOB:


Participant's Age:


Select Level of Play

 PR C1 C2 C3 REC

Address:


City, State and ZIP code:


Additional Info: