Little Kickers Soccer Clinic

Sponsored by
Jersey Knights Soccer Club

Name:___________________________

Address: _________________________

TownZip:_________________________

Birth: ____________________________

Email:____________________________


Location: Jersey Knights Complex
Dates:  5/2, 5/9, 5/16/ 5/30, 6/6, 6/13
Time: 6:30 - 7:30 Cost: $110.00

Mail to:                                                                                                                                                                                                                                   Little Kickers Soccer Clinic
993 Shepard Avenue
North Brunswick, NJ 08902

Make Checks payable to: Jersey Knights Soccer


Directions: The Jersey Knights Complex is easily accessible from Route #130 North or South.  For detailed directions click below:  

                                        Jersey Knights Complex

Medical Information

Name: _____________________________ Date: ___________

In Case of a medical emergency contact the following person/s.

Emergency Contact #1 : ___________________________ Phone: ______________

Emergency Contact #2 : ___________________________ Phone: ______________

List any medical concerns we need to be aware of—Medications, allergies, conditions, etc.: ____________________________________________________________________

____________________________________________________________________