Brazilian Soccer Training Center Program Registration Form
AFTER SCHOOL SOCCER PROGRAM REGISTRATION Price Per Season $380.00 FALL: Aug 2014 - Nov 2014 WINTER: Nov 2014 - Feb 2015 SPRING: Feb 2015 - May 2015 SUMMER: Jun 2015 - August 2015 TUESDAYS AND THURSDAYS 5:00 PM - 6:30 PM
Brazilian Soccer Training Center Program Registration Form Coach Director João Moraes Free one set of soccer uniform when registering at the beginning of the season. After the season has started soccer uniform set cost is $ 30.00 Child Name: _______________________________ School Attending: _____________________________ D.O.B.: ___________________________ Age: ______________________________ Parent email: ____________________________________________________ Parent Name: ___________________________________ Home Phone: ___________________________________ Cell: ___________________________ How did you hear about us: _______________________________________________
PARENTAL RELEASE I hereby certify that ________________ is in normal health and capable of participating in the soccer program. I am aware the goals and the objectives of BRAZILIAN SOCCER TRAINING CENTER (BSTC), INC. and sports program based on fun, fair play, and skills development. I’m aware that BSTC, INC., only carries a secondary health insurance bears primary responsibility. I also understand the BSTC, INC. retains the right to use, for publicity and advertising purpose photographs of players taken at the school or any event by BSTC, INC.
NOTE: No refunds after the first schedule week of practice Signed:
Date:
Print Name: _______________________
PAYMENT INFORMATION Payment can be made by Visa or Master Card or by Check to Brazilian Soccer Training Center. Check # : . Credit Card Type: Master Card ( ) Visa ( ) I authorize BSTC to charge my CC the amount of $______ Credit Card #: . Expiration Date: CVV Code: _________________________ Signature: ____________________________ Date: ____________________________ Card Holders Name: Card Holders Address: ________________ City: State: Zip Code: Phone: _____________________ Email: ______________________________________________________________ MAILING ADDRESS: ______________________________________________ FILL OUT FORM EMAIL OR FAX REGISTRATION FORM TO Brazilian Soccer Training Center [email protected] Phone 1.800.509.5344 . Fax 305.865.4382
Brazilian Soccer Training Center Program Registration Form Coach Director João Moraes Free one set of soccer uniform when registering at the beginning of the season. After the season has started soccer uniform set cost is $ 30.00 Child Name: _______________________________ School Attending: _____________________________ D.O.B.: ___________________________ Age: ______________________________ Parent email: ____________________________________________________ Parent Name: ___________________________________ Home Phone: ___________________________________ Cell: ___________________________ How did you hear about us: _______________________________________________
PARENTAL RELEASE I hereby certify that ________________ is in normal health and capable of participating in the soccer program. I am aware the goals and the objectives of BRAZILIAN SOCCER TRAINING CENTER (BSTC), INC. and sports program based on fun, fair play, and skills development. I’m aware that BSTC, INC., only carries a secondary health insurance bears primary responsibility. I also understand the BSTC, INC. retains the right to use, for publicity and advertising purpose photographs of players taken at the school or any event by BSTC, INC.
NOTE: No refunds after the first schedule week of practice Signed:
Date:
Print Name: _______________________
PAYMENT INFORMATION Payment can be made by Visa or Master Card or by Check to Brazilian Soccer Training Center. Check # : . Credit Card Type: Master Card ( ) Visa ( ) I authorize BSTC to charge my CC the amount of $______ Credit Card #: . Expiration Date: CVV Code: _________________________ Signature: ____________________________ Date: ____________________________ Card Holders Name: Card Holders Address: ________________ City: State: Zip Code: Phone: _____________________ Email: ______________________________________________________________ MAILING ADDRESS: ______________________________________________ FILL OUT FORM EMAIL OR FAX REGISTRATION FORM TO Brazilian Soccer Training Center [email protected] Phone 1.800.509.5344 . Fax 305.865.4382
