Use your credit card with
peace of mind. This page is protected with the Secured Socket Layer (SSL)
encryption to ensure your credit card transaction is safe. Click
the padlock on your screen for
security information.
3 Easy Ways to Register:
1. Register
online by completing this secure
registration page.
2. Register by
phone with your Visa or MasterCard.
Call (732) 563-2525
3. Register by
mail using check or credit card.
Click
here for a printable registration form.
Family Details
Required fields
marked with "●"
Last Name
●
Parents First Name
●
Street Address
●
City
●
State
●
Zip
●
Home Phone
●
Cell / Day Phone
●
Emergency Phone
●
E-Mail
●
Ensure your email
is correct. We will use this email address to notify you of any changes.
Player 1
Click the back
button on your browser if you need to get the camp/class details. You will not
lose your inputted information.
Player 1 Details
Name ●
Date of Birth
●
Month
Day
Year
Age ●
Gender ●
Team Name
(If applicable)
Player 1 Camps / Classes
Camp / Class 1:
(If app.)
Location:
Code:
Fee:
Camp / Class 2:
(If app.)
Location:
Code:
Fee:
Camp / Class 3:
(If app.)
Location:
Code:
Fee:
Player 2
(If applicable)
Player 2 Details
Name
Date of Birth
Month
Day
Year
Age
Gender
Team Name
(If applicable)
Player 2 Camps / Classes
Camp / Class 1:
(If app.)
Location:
Code:
Fee:
Camp / Class 2:
(If app.)
Location:
Code:
Fee:
Camp / Class 3:
(If app.)
Location:
Code:
Fee:
If
you need to enroll more than two children please submit a second online form
or call our head office on (732) 563-2525
Payment
& Registration Information
Total Fees Player 1
●
$
Total Fees Player 2
$
Promo Code if applicable
Limit one coupon or
promo code per family registration per program type. Coupons or Codes cannot be
used in conjunction with other promotional offers for the same type of program.
Total Fee Due
●
$
Card Type
●
Name on Card
●
Card Number
●
Expiry Date
●
Month
Year
Please provide
information on any medical issues that you feel we should be made
aware of:
Office Use Only
I hereby agree to let my child participate in the sporting
activities on this camp or program. I
understand that there are certain risks of injury inherent in the practice and
play of these sports, as well as in traveling and other related activities
incidental to my participation, and am willing to assume these risks. I hereby
certify that my child is fully capable of participating in these sports
and that he/she is healthy and has no physical or mental disabilities or
infirmities that would that would restrict full participation in this activity,
except as included in writing with this application. In addition to giving full
consent for my child's participation, I do hereby waive, release and hold
harmless United Soccer Academy, inc., its officers, coaches, sponsors,
supervisors and representatives for any injury that may be suffered by my child
in the normal course of participation in these sports and the activities
incidental thereto, whether the result of negligence or any other cause. I grant
permission for my child to receive emergency medical treatment. I grant United
Soccer Academy,
Inc., permission to use photographic or video images of my child in future
promotional materials.
1.
Players should bring a soccer ball, snacks and
water to class. It is recommended that shin guards, soccer shoes or sneakers
be worn.
2.
Merchandise may be sold on programs.
3. Your
cancelled check is confirmation that your place is confirmed. If you require
additional confirmation of enrollment please include a stamped, S.A.E.
4. Refunds will not be issued
in the event of non-participation.
Administration fee of $50 will be charged for
all
cancelled registrations where a refund is
requested. A credit voucher for the full registration fee is available in
place of a refund.
5. No refunds or credits will be issued once a
program or camp has started. 6. If
a portion of the class is cancelled by USA due to adverse weather conditions
and the time is unable to be made up then a pro rated credit voucher will be
issued. Cash refunds will not be issued in the case of weather
cancellations. In
the event of inclement weather please call the Rain-out line at (732)
563-2538 -
Do not call the main office for rain-out information.
I have read the
above release and I agree that by selecting ‘YES‘ in the box below
that I accept all terms & conditions as stated. I also attest that I
am a legal guardian of the children which I am registering. I also
approve my credit card to be charged for the amount indicated in the
'Total Fee Due' Box.
If you do not select 'yes' then your order cannot be processed.
●
Click Submit once only
- It will take a few moments for your registration to process.
