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Winter 2021
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Child Information
Child Name:
Child Grade:
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3
4
5
6
7
8
9
10
11
12
School Attending:
Parent Name
Address (include city)
Parent Cell Phone Number:
Parent Email Address(es)
Requested Information
Child Date of Birth
Child Gender
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M
F
Most Recent Team Played on
Preferred Payment Method
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VENMO app
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Pay in person at gym
Check to 61 Oleander Drive Northport 11768
Please look for email charging preferred payment method listed. Additional comments:
Additional Info
Text OK to contact
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Yes
No