Paye's Place Summer Skills Soccer Clinic Registration Form

August 23rd, 24th, 25th, 26th, 27th, 2010

Director "Tim Nixon" Former Pro Soccer Player for San Jose Earthquakes

MorningSession II (9am to 12pm)
Cost: $175
Ages: 6 to 15

*drop in rates, must be paid at the door (by check or cash) $50 per session/per day

*Download Payes Place Waiver - Release Form - Fill it out and bring in to Office before camp starts.

Information about you
DOB
Athlete's Name
Parent Name
Address
City
St
Zip

How do we Communicate with you?
Home Phone:
Email:
CellPhone:

Pay By:    Check    Credit Card    *Payments

Credit Card Information
*Fill this section out below if you clicked to pay by credit card, otherwise just click I accept.
Credit Card Type
Credit Card Number
Expires
Card Security Code
Name
Street
City
State
Zip
 




I understand that I have signed up for Paye's Place Summer Skills Soccer Clinic. I am committed to attending the clinic. No Refund Policy.

Checks are payable to Paye's Place

Thank You,

595 Industrial Rd. San Carlos, CA 94070 - (650)654-4444 Fax (650)508-8710