Summer 2010 Lil' Kickers Session June 15-August 28             Registration Form Please print this out and fax with a waiver to 707-581-2044, or mail it to: Sports City, Attention Lil' Kickers, 921 Piner Road, Santa Rosa, CA 95403 Questions:  please call 707-526-2884.  You can also come to either facility and register in person. Register at any time during the session! Childs Name Registering for:   Summer 2010 Session  Dates: June 15-August 28  Membership Waiver PDF   Membership Waiver Spanish PDF required to complete registration Please select the class(es) you are registering for. Bunnies (18 - 24 months) Parent and Child Classes Wednesday 9:30 AM Santa Rosa Thursday 9:30 AM Cotati Thumpers (24 - 36 months) Parent and Child Classes Thursday 10:30 AM Cotati Friday 9:30 AM Santa Rosa Saturday 9:00 AM, 10:00 AM  (circle one) Santa Rosa Saturday 10:00 AM Cotati Cottontails (30 - 42 months) Parent and Child Classes Tuesday 9:30 AM Cotati Wednesday 9:30 AM Santa Rosa Friday 9:30 AM Santa Rosa Saturday 9:00 AM Santa Rosa  Hoppers (3-4 years)  Beginning Tuesday 10:30 AM Cotati Wednesday 10:30 AM Santa Rosa Friday 3:30 PM Santa Rosa Saturday 9:00 AM, 10:00 AM  (circle one) Santa Rosa  Saturday 11:00 AM Cotati Jackrabbits (3-4 years)  Intermediate Friday  10:30 AM Santa Rosa  Saturday 10:00 AM Santa Rosa Big Feet (5-6 years)  Beginning Thursday 4:30 PM Cotati Saturday 10:00 AM Cotati Saturday 11:00 AM Santa Rosa 4-5 Micro (4--5 years) Wednesday 10:30 AM Santa Rosa Friday 4:30 PM Santa Rosa Saturday 11:00 AM  Santa Rosa or Cotati  (circle one) 6-9 Micro (6-9 years) Thursday 4:30 PM Cotati Saturday 11:00 AM Santa Rosa or Cotati (circle one) Refund Policy Full refunds will be issued if the request is received prior to a session beginning or within 7 days after the date of your first class.  If a refund is requested after the first 7 days of the session start date or date of your first class, a $20 cancellation fee will be charged in addition to the price of classes that have already taken place during the session.   Credit card payment information (MasterCard/Visa only. Cash/checks are not accepted):                                                                                Credit Card Number:  Expiration Date:   Amount  $ Name on Credit Card:                    Signature: All information is kept confidential. $35 for Annual Membership (required for all Lil' Kickers)

PLAYER INFORMATION: To be completed by Parent/Legal Guardian Returning Lil' Kicker? YES      NO Player Name (First, Last) Date of Birth            Age          Sex Street Address City State Zip Parent/Guardian Name Home PhoneWork Phone Cell PhoneE-Mail Address Emergency Contact Emergency Phone

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