Account Holder Information
First Name * * Required Field
Last Name *
Address *
City *    State *    Zip *
Home Phone * () -
Mobile Phone () -
Work Phone () - Ext

Alternate Point of Contact (copied on all emails)
First Name
Last Name
Login Information
Email *
Password *
Password (Confirm) *
Password must be at least 6 characters long with 1 capital letter and 1 number.

How did you hear about Pro Soccer Kids?

Email Subscription Preferences
Per our policy, we'll always send emails for classes cancelled due to weather.
Promotions New class details, newsletters and important updates
Child Birthday Happy birthday wishes for each child on their special day

Payment Information
Payment method

Child Information
1 FirstName *
Middle Name
Last Name *
Birthdate *
Gender *
Relationship *
Emergency Contact Name *
Emergency Contact Phone *
() -
Pediatrician Name
Pediatrician Phone
() -
Medical Condition(s)
Please indicate any relevant medical conditions or allergies your child may have (not required if your child has no relevant medical issues)