Parowan High School
             
The Summer Soccer Showcase 2018
(5 on 5 co-ed competition)

Date: Saturday July 12, 2019
Time: 9:00 am to Midnight
Location: Parowan High School Football Field

Divisions: Jr. High, High School & Open (18+)

Registration due by Saturday June, 29th
For more information contact:
Lindsey Delcore
lindsey.delcore@ironmail.org
Phone (435) 531-6020

or
Becca Evans
bchat4@gmail.com
Phone (615) 260-3933
 
Coach/Team Representative
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
 
Team Name
Divisions
 
Team Fee:   $150.00   Item Subtotal:  
$150.00
 
Total:
$150.00
 
 
Payment Information
Method of Payment:
Processing Fees: Credit cards: 3% plus $0.50 ($1.50 min)
                    (+1.50% processing fee for AMEX cards)
                    (+1.5% processing fee for foreign cards)
eChecks: $0.49
Update name from Coach/Team Representative
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number: (Type number or swipe with cursor in this empty field)
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Coach/Team Representative
Cardholder's Name:
Billing ZIP/Postal Code:
 
Signature/Acknowlegment
We (Parent, Player, Coach) acknowledge and fully understand that my child/I will be participating in sport activities that carry innate risk for bodily injury. By checking this box and entering name below, We (Parent/Player/Coach) agree to hold harmless the coaches and/or representatives of this soccer competition, Parowan High School, and/or the City of Parowan.
 
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