1. Sign Up

Class Information

Location: Salem : River Road Park Day: Monday Class: Tot/Pre Soccer (3 1/2 - 5 yrs) Time: 4:45-5:20pm Dates: 6/18/18 — 8/6/18 Meetings: 7 Class Price: $83.00

Student Information

*First Name:

Last Name:

Date of Birth: (mm/dd/yy)

Parent/Guardian Contact Information

First Name: Address/P.O.Box: City:

Last Name: Suite or Apt.: (optional)

State: ZIP/Postal Code: Country: Email Address:

Phone #1:

ext.

Phone #2: (optional)

ext.