Kids Move for Soccer has limited enrollment to maintain an effective child to coach ratio. Registration will be accepted on a first-come, first-serve basis. Enrollment in a class cannot be guaranteed. A letter of acknowledgment that your child is enrolled will be sent out 2 weeks prior to the start of the first class. The earlier you send the registration in, the greater the possibility your child will be enrolled in the class.

Pre Registration
Participants will have registration priority until March 20th, for spring enrollment and August 20th for fall enrollment.

Registration will not be accepted before:
February 15th for the Spring Season
July 15th for the Fall season

Any application received before the above dates will be sent back to you!

Please download and print PDF file for application

or print this form

Send with check to:

James Fowler P.T., P.C.
44 Butler Place, #5J
Brooklyn, NY 11238
Phone: 718-638-7354

KIDSMOVE FOR SOCCER REGISTRATION

Child Name: ____________________________________
Date of Birth __________________
Address _____________________________________________________________                Street                                   Apt    City                     Zip
Parents or Guardian Names:
1_____________________________________ 2:____________________________________
Home Phone ___________________________
Cell __________________________________
Email:_________________________________
Classes (circle one)
4. y.o. / 4-5 y.o . / 5 y.o. / 5-6 y.o. / 6-7 y.o.

Cost: $115 for 4 to 7 year olds
Cost: $150 for 8 to 10 year olds

MAKE CHECKS PAYABLE TO: JAMES FOWLER P.T. P.C.

I understand that, as with any other physical activity, it is possible that injury may occur. I understand and agree that if any injury should occur during class I shall hold ìKidsMove for Soccerî and all of its coaches, therapist, aides harmless for any injury and waive any claims or damages against them.

_______________________________________________ ___________
Print Name                    Signature                                   Date

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Office use only
Child Name _______________________________________________
Date of Birth ___________________ Age_____________
Class __________________________
Parents Name_________________________________________________________
Phone Numbers Home ___________________________________________
Cell ____________________________________