A Soccer CLINIC, The Fieldhouse way!

Participant Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth *

MM

DD

YYYY

Which session(s) will you be attending? *

November 7

November 14

November 21

December 5

December 12

December 19

Will you be paying by check or credit card? *

If you are paying by credit card, upon pressing submit on this form, you will be brought to our online payment portal. If you are paying by check, all checks can made out to The Fieldhouse and be mailed to our address, 2 South Winchester St. Swanzey, NH 03446. Checks must be delivered prior to or on the date of the session. It is $75 for all six sessions of our Sunday Clinics or $20 for an individual session.

Check

Credit card