Online Program Registration

 

Winter Soccer Klinic (Three 5-week sessions)
 
Choose Session(s):
     
Session I: December 3, 2011 - January 14, 2012 (no class Dec 24 & 31)
Session II: January 21, 2012 - February 18, 2012
Session III: March 3, 2012 - March 31, 2012
     
Saturdays:

Boys & Girls
  5-6 yrs old / 9:00 - 10:00 am
  7-10 yrs old / 10:00 - 11:00 am
   

Location:

Omni Health & Fitness, Pelham Manor

Cost:

 $125 per session or
  $30 per class


Player's Information

Name
Date of Birth
Address
City       State       Zip
Home Phone       Alternate Phone


Emergency Contact Information

Contact Name Relation
Phone Work Phone
E-mail    


Payment

If paying by check, make payable to:

Klassic Soccer

P.O. Box 1408

New Rochelle, NY 10802

If paying with PayPal, select a PayPal option on the Programs page.


Disclaimer

The designated parent/guardian acknowledges that there are inherent risks involved with participation in recreational activities that may cause physical injury. The parent/guardian hereby consents for the abovementioned child to participate in Klassic Soccer’s klinic/kamp and unconditionally agrees that Malcolm Brown (& Staff) and Omni Fitness will be hereby expressly released and discharged forever from any and all actions or causes of action, acts of active or passive negligence from the child’s involvement in the klinic/kamp.

I hereby certify that my child is in good physical health and may participate in the klinic/kamp related games and activities. In case of emergency, I grant permission for my child to be given emergency treatment at a local hospital.

I hereby give permission for the use of photos and/or video klips taken at KS's klinic/kamp to be used for publicity and marketing in brochures/flyers, and posting on KS's web site.

I consent

I do not consent

 

NOTE: You must consent in order to participate in Klassic Soccer's programs

 

 
 

Klassic Soccer | PO Box 1408, New Rochelle, NY 10802 | Phone/Fax: (914) 654-1740 | E-mail: Malcolm@Klassicsoccer.com