Winter Soccer Registration

Child #1 *

First Name

Last Name

Child #2 (if applicable)

First Name

Last Name

Child #3 (if applicable)

First Name

Last Name

Choose Sessions *

Kinder / 1st Grade - Thursdays 1:30-2:30 PM

2nd Grade - Mondays 1:30-2:30 PM

2nd & 3rd Grade - Thursdays 3:15-4:15 PM

4th - 6th Grades - Mondays 3:15-4:15 PM

4th - 6th Grades - Wednesdays 3:15-4:15 PM

4th - 6th Boys Semi Private Lesson - Tuesdays 3:15-4:15 PM

4th - 6th Girls Semi Private Lesson - Saturday 9:45-10:45 AM

4th - 6th Grade Scrimmages - Jan. 20, Feb. 3, & March 9; 11:00AM -12:00 PM

Parent Name *

First Name

Last Name

Phone *

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Waiver of General Liability *

By checking this box, I am releasing Patrick Ianni, Pristine Vibrations LLC, and their staff from any liability for my child's participation in any soccer or non-soccer related activities that take place prior, during or after soccer class. I also understand that there is an inherent risk in playing sports.

Payment Method (Needs to be completed by December 15th to take advantage of Early Bird Pricing) *

Cash/Check

Zelle

Venmo

Paypal

Parent Signature

First Name

Last Name