Paye's Place Summer Speed & Agility Clinic Registration Form

August 8th, 9th, 10th, 11th, 12th, 2011

Morning Session I (9am - 12pm)
Afternoon Session II (1pm - 4pm)

*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 clinic starts.
Choose your Clinic session or sessions.
   Session I - 9am - 12pm ($175)
   Session II - 1pm - 4pm ($175)
   All Day - Both Sessions ($325)

Information about you
DOB
Athletes Name
ParentName
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 Speed & Agility 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