Please complete the following contact form so that we can process your Private Lesson or Game Evaluation request accurately and efficiently.  k here for info on indoor sessions.
	Family Information
	Parent Name
	Street Address
	Town / City
	State	... NJ NY PA MD DE
	Zip
	Home Phone
	Daytime Phone
	E-Mail
	Player Information
	Player Name
	Age	... 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
	Gender	... Male Female
	Level of Play	... Beginner Recreation Team Travel B Team Travel A Team Select Team High School Freshmen Team High School Junior Varsity Team High School Varsity Team Collegiate
	Current Team
	Please enter 'none' if player is not registered to a team
	Aims of Training
	If you are unsure of program aims the USA staff member will be able to provide insight and develop an appropriate program. For Small Group training just enter the name of one child.
	Scheduling Information
	I am interested in the following program type:
	Private Training: 1 Player
	Small Group Training: 2-4 Players
	I am interested in the following sessions:
	Platinum Package - 10 or more sessions
	Gold Package - 8 sessions
	Silver Package - 6 sessions
	Foundation Package - 4 sessions
	Individual - 1, 2, or 3 sessions
	Single Game Evaluation
	Multiple Game Evaluations
	Requested Coach
	If you have no preference please state: 'any'.
	Location
	Please give an indication of where the sessions will take place. For game evaluation you must be prepared to give specific field directions.
	Preferred Days	Mon  Tue  Wed  Thu   Fri  Sat  Sun
	Please select days that would work for training. Select all that apply.
	Preferred Times
	Please indicated you preferred start times for the training. For a game evaluation enter the exact game start time. The trainer will arrive 30 minutes prior to game time to observe the warm-up.
	Start Date
	Please indicated the date you would like your sessions to start. For a game evaluation enter the exact game date.
	After you submit your request it will be reviewed by the USA scheduling department.  Your sessions are NOT confirmed until you receive either email or phone confirmation from the scheduling department
	All sessions must be scheduled with our central office prior to the commencement of the program.  U.S.A. reserves the right to cancel sessions and issue a pro rated refund should the need arise.  Rates may be higher dependant on the staff member requested.
	Thank you for choosing United Soccer Academy
	Click Submit once only It will take a few moments for your registration to process.