DAY CAMPS >> REGISTRATION FORM

Use this form to register for an upcoming day camp.  All personal and credit card information is collected using a secure connection with encryption and is kept confidential for your added security. All fields are required.

PLEASE NOTE:
If you would prefer to send your registration, please CLICK HERE to download a PDF registration form and send to:
ONE on ONE Soccer, 786 Sylvan Road, Lancaster, PA  17601
Fax number:  (866)462-2429

PLAYER INFORMATION

Full Name:   
Address: 
City:   
State:
Zip: 
Player Email: 
Parent Email:
Phone Number:   
Emergency Contact:
Emergency Phone:
Gender: 
Age: 
Birth Date: 
Any Medical Issues? 
Current Soccer Club:
Soccer Club Coaches Name: 


PROGRAM SELECTION
 

Program Type:   
Session Date
Session Time:
Tuition Price:
T-Shirt Size:
Short Size:
Ball Size:                                              


PAYMENT INFO

All personal and credit card information is collected using a secure connection with encryption and is kept confidential for your added security.

Select Card: Visa   MasterCard
Credit Card Number:
(Please format with dashes)
(ex: 4111-1111-1111-1111)
Expiration Date:
Name on Credit Card:
Amount to be Charged:


AGREEMENT

I hereby give consent and authorize ONE on ONE Soccer to charge the above credit card accordingly towards payment of tuition for the day camp selected.