PMC Kids Soccer - Islamic Center of Peoria

2019-2020 PMC Kids (Boys) Registration

Parent Name *

First, Middle, Last

Parent Phone Number *

Parent Email *

Home Address *

Emergency Contact (Name & Phone Number) *

List of Participants

Child(ren) Name(s) *

Acknowledgment

Please read and acknowledge the disclaimer below

Please Acknowledge *

I apply for Peoria Muslim Club Soccer Club membership for my children between the age of 5 & 12 and agree to comply with the bylaws and policies of Peoria Muslim Club and Islamic Center of Peoria. I, also, agree on behalf of the names above to release and hold harmless Peoria Muslim Club, Islamic Center of Peoria, their officers, directors, employees, and agents, and each of them, from any claims, demands, or actions we may have against them because of this application

Fees

Price: $80.00

($60 for each additional child)

Email

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