LMSC Summer Program

Child's Last Name*

Child's First Name*

Address*

Street Address City State ZIP Code

Primary Phone Number*

Secondary Phone Number (Optional)

E-Mail Address 1*

Enter Email Confirm Email

Secondary E-Mail Address (Optional)

Enter Email Confirm Email

Parents' Names (Dad and Mom)

Gender*

Male
Female
Other

Birthdate*

Current Club / Team / Head Coach*

Current Level Of Play WIthin Your Club

Position*

Please check which position(s) you wish to be considered for.

Field Player
Goalie

Uniform Size*

Select Participation Level*

Full Program: Training and Both Tournaments ($500)
Training Only, No Tournaments ($400)
First Tournament Only ($150)
Second Tournament Only ($150)
Both Tournaments, No Training ($300)

All players applying for the LMSC Summer Program will be required to put down a deposit of $150. The balance of the fee will be collected at a later date. There will be a bank charge of $4.65 added to the deposit.

Summer Program Deposit*

Price:

Bank Fee*

Price: $0.00

Credit Card

Card Details

Cardholder Name

ADDITIONAL COMMENTS

Please feel free to enter any additional comments here: