Child's First Name:

Child's Last Name:

Street Address:

City:

State:

Zipcode:

Boy/Girl:

Date of Birth:

Month

Day

Year

Parent 1 First Name:

Parent 1 Last Name:

Email:

Cellphone:

Area Code

First 3 digits

Last 4 digits

Parent 2 First Name:

Parent 2 Last Name:

Email:

Cellphone:

Area Code

First 3 digits

Last 4 digits

Payment:

Teammate Request:

If your child wants to be on the same team as another player, please enter the request here. Requests can only occur for players of the same age group AND in the same package

By checking this box, I understand that this payment is nonrefundable after 96 hours of making an online payment. There are no exceptions regardless of reason or circumstance. I have also read the Payment and Privacy policy.

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By checking this box, I agree to comply with the requirements outlined in the academy program rules. I also agree to sign the Membership Agreement.

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