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Bethany: Fall 2009 Enrichment Program
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First Name*
First Name*
Last Name*
Last Name*
E-mail Address*
E-mail Address*
Street Address
City*
City*
Home Phone*
Home Phone*
Business Phone*
Business Phone*
Participants Name *
Participants Name *
Participant grade*
Participant grade*
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K
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7th
8th
Participant Class Selection*
Participant Class Selection*
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K-3rd 3:10-4:10
4th-8th 3:20-4:20
Participants Name #2
Participant #2 Grade
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K
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2nd
3rd
4th
5th
6th
7th
8th
Participant #2 Class Selection
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K-3rd 3:10-4:10
4th-8th 3:20-4:20
Participants Name #3
Participant #3 Grade
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K
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2nd
3rd
4th
5th
6th
7th
8th
Participant #3 Class Selection
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K-3rd 3:10-4:10
4th-8th 3:20-4:20
Participation Agreement *
Participation Agreement *
I agree to my child participating in Just4kicks-Solano Inc. soccer classes. I further agree that I will not hold Just4kicks-Solano Inc., its sponsors, or field owners responsible in case of an accident or injury. I understand that no accident insurance is provided.
