Registration Page
All information with a red asterisk (
*
) is required.
Last Name
*
First Name
*
Nick Name
Birthday
mm/dd/yyyy
*
Sex
-- Choose One --
Female
Male
Age Group
*
-- Choose One --
3&4 Yr. Old
5&6 Yr. Old
7 Year Old
8 Year Old
9 Year Old
10 Year Old
11 Year Old
12 Year Old
13 Year Old
1&2 Yr. Old
14 Year Old
15 Year Old
16 Year Old
17 Year Old
18 Year Old
Program
*
-- Choose One --
$1593#
$25 Soccer League
Spring 2018 Soccer League
Travel Soccer Tryout
Winter Basketball 2019
Science Club Fall - 2018
Science Club Winter - 2019
Science Club Fall Winter
Theatre Club - Fall 2018
Theatre Club - Winter 2019
Theatre Club - Fall Winter
Arts and Crafts Club - Fall 2018
Arts and Crafts Club - Winter 2019
Arts and Crafts Club - Fall Winter
Spring 2019 Soccer League
Free Soccer Clinic
Winter Soccer II
Travel Soccer Spring 2019
Address
Address Line 1
*
Address Line 2
City
*
State
*
Zip Code
*
Phone
*
Other Phone
Email
Email
*
Other Email
Contact Phones
Father's Information
Last Name
First Name
Cell Phone
Mother's Information
Last Name
First Name
Cell Phone
Emergency Contact
Last Name
First Name
Phone
Additional Information
.
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Please send check or money order to confirm individual registrations to:
Programs 4 All Kids
3280 Sunrise Hwy
Suite #279
Wantagh, NY 11793
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