Kiddie KickerZ Online Registration

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Welcome to Kiddie KickerZ! We are so excited that you are here!! Kiddie Kickerz Classes - Enrollment is open....feel free to sign up at any point...we will prorate the month for any missed sessions in your first month. tuition: 4 classes/month (once a week)is $60/mo--------8 classes/month (twice a week) is $100/mo ------ Junior Kickerz Academy (5.5 - 8 years old) 4 classes/month (once a week): $80/

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Referral Information

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Home Address*

City*

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Zip*

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Contact #1

Contact #1 First Name*

Last Name *

Type*

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Contact #2

Contact #2 First Name

Last Name

Type

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Work #

Cell #

Email (Emails are kept confidential)

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Student #1

Student's First Name*

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Student Gender*

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Additional Info

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Student #2 (Show-Hide Details)

Student's First Name*

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Birth Date*

Additional Info

School

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Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School

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Student #4 (Show-Hide Details)

Student's First Name*

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Student Gender*

Birth Date*

Additional Info

School

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Student's First Name*

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Additional Info

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Address Line 2

City

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Zip*

Registration

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Family Information

Where do you live?

Contact #1

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Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

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