Name: Volleylites Youth Training Session #2
Start: 2019-11-17T17:00:00-06:00
End: 2019-11-17T19:00:00-06:00
Location: Good Samaritan Health & Wellness

	
	
	
	

			
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	Athlete First Name*
	
		                
        
    					


	Athlete Last Name*
	
		                
        
    					


	Athletes Birth Date*
	
		                
        
    					


	Athletes School*
	
		                
        
    					


	Athletes Grade*
	
		                
        
    					


	Parent First Name*
	
		                
        
    					


	Parent Last Name*
	
		                
        
    					


	Address*
	
		                
        
    					


	City*
	
		                
        
    					


	Zip*
	
		                
        
    					


	Parent Email Address*
	
		                
        
    					


	Parent Cell Phone #*
	
		                
        
    					


	Volleylites Session*
	
		            
                Session #1
            
		            
                Session #2
            
		            
                Session #3
            
		            
                Session #4
            
							


	Payment Type*
	
		            
                Check to IPV
            
		            
                Cash
            
		            
                Charge + 3.4% service fee
            
				Payment by cash or check is due at check-in on first day of session.			


	Charge Card # (Visa/MC/Discover only)
	
		                
        
    					


	Card Expiration Date
	
		                
        
    					


	Charge 3 digit code on back of card
	
		                
        
    					


	Enter Signature used on charge card
	
		                
        
    					


	What is 2 + 4*
	
		                
        
    					
	
        

        		
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