HALO/Capital City Soccer Training

HALO/Capital City Soccer Training
PLEASE SELECT LOCATION*
Select your school for pick-up
PRIMARY GUARDIAN*

First NameLast Name
PRIMARY GUARDIAN'S EMAIL*
example@example.com
PRIMARY GUARDIAN'S PHONE*

Area CodePhone Number
SECONDARY GUARDIAN

First NameLast Name
SECONDARY GUARDIAN'S EMAIL
example@example.com
SECONDARY GUARDIAN'S PHONE

Area CodePhone Number
CHILD'S NAME*

First NameLast Name
CHILD'S DATE OF BIRTH*

MonthDayYear
Date
MAIN ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PAYMENT*

product

4 sessions (4:15- 5:30)$195.00

Small group soccer skills training with pick up

product

8 sessions (4:15-5:30)$380.00

small group soccer skills training with pick up

Total $0.00

CREDIT CARD

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Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

BILLING ADDRESS

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

BILLING EMAIL ADDRESS*
example@example.com
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