Soccer Shots Boise Registration

You are registering for:
Ten Mile Community Church Daycare (Summer 2010, 6-8 yr olds)
Dates: 07/05/10 - 08/23/10 (10:40-11:15 am)
Price: $70.00

All fields are required unless otherwise noted.

Child Information

Name First Last
Birthdate MM/DD/YYYY
Gender
Special Needs
E.g. Allergies, Disabilities, etc.
Classroom Only if you know it.

Parent Information

Name First Last
Address
Use second line only if applicable.
City
State/Province
Zip/Postal Code
Phone
XXX-XXX-XXXX
Email Address
Used to send you a receipt and important updates.

Emergency Contact

Same as Above
Name First Last
Phone
XXX-XXX-XXXX

Important Stuff

I have read and agree to the Policies.
I have read and agree to the Waiver and Release.

Have a coupon code?
Click here to redeem it.

We've partnered with Paypal to ensure that your credit card transactions are convenient and secure.