BLAST HOME SCHOOL Registration Form

(Include Questions in Staff Notes)

Price: $65 for 8 Sessions  or Pay at each Session - $10 per session
Child's Name    
Parent/Guardian's Name    
Address  
City  
State    Zip  
Phone #1  
Phone #2  
E-mail Address  

I am registering a:

Team Maverick (Individual Registration)
Team Name  

Age 

Adult    Youth Age
  Male    Female
Date of Birth  

Choose the League you wish to register for:
Payment Information
Payment is accepted online.  Acceptance into a BLAST league or event is not guaranteed until payment is received. Submission of this registration form will generate an invoice mailed to the registered address.
 

Payment Options - Price: $65 for 8 Sessions

    

 

 Bill Me Visa Master Card
 
Cardholders Name
Card Number - - -
Expires
(if different from above) Address on Card
(if different from above) Zip Code
V-Code   (What is a V-code?)
   
Roster and Waiver
Teams are required to submit a Roster of players and abide by the Norms and policies of the BLAST (NORMS AND POLICIES... Click Here). Each participant (or adult parent or guardian) must acknowledge by signature a waiver of liability prior to participation.

I Accept the above terms

I Decline the above terms
 
Info to our Staff
Please include any information we need to know below (Scheduling Requests)!

Copyright © 2003 Trident Sports Inc. All rights reserved.
Revised: 09/04/08.