Soccer Stars RSVP

Soccer Stars Application
Please contact Chanie Baitelman with any questions! 818-262-5016 or Info@ValleyFriendshipCircle.com
Full Name*

First Name Last Name
E-mail*
I would like to receive news and updates by email
Phone Number*

Address

AGREEMENT:
I agree to release the Valley Friendship Circle and its providers and administrators, from all liabilities for any incident which affects the health, welfare and safety of my child during the provided transportation.
I agree to the Liability consent:*

Yes
I give permission to The Valley Friendship Circle to transport my child to and from excursions while my child is in their care. I agree to release the Valley Friendship Circle and its providers and administrators, from all liabilities for any incident which affects the health, welfare and safety of my child during the provided transportation.
I accept the Transportation Consent. (By not agreeing to these terms, I am choosing to arrange transportation for my child to and from trips).*

Yes
Emergency Information:
Emergency Contact*

First Name Last Name
Phone Number*
Relationship:*
PARENTAL CONSENT:
I hereby give consent for my child to participate in all activities of Valley Friendship Circle Summer Circle both on and off site, trips, transportation to and from trips etc., unless I advise you otherwise in writing.
Signature of Parent/Guardian:*
Full Name

First Name Last Name
Choose dates:*

09/04/2409/11/2409/18/2409/25/2410/02/2410/09/2410/30/2411/06/2411/13/2411/20/2412/04/2401/08/2501/15/2501/22/2501/29/2502/05/2502/12/2502/26/2503/05/2503/12/2503/19/2503/26/2504/02/2504/09/2504/23/2505/07/2505/14/2505/21/2505/28/2506/04/25
$60 Fee Per Class

10 week sessions
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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Programs

Soccer Stars Application