Primary Prep Soccer Registration

To register your child for Primary Prep indoor soccer, please complete all the fields below and click submit. You need to supply a credit or debit card for payment on this form. Tuition charges will be processed within 72 hours after registration. You only need to complete this form to submit your registration. Classes will be held from October through December 2021. We thank you for your participation! Questions? Call Coach Alex at 201-920-8523. *

I am ready to register my child.

Player's Name *

First

Last

Primary Prep 2021 Soccer Class Enrollment (Select One)

Pre K (4) - Monday @ 3:00pm to 3:40pm (SOLD OUT - WAIT LIST)
First Grade - Monday @ 3:50pm to 4:30 pm
Kindergarten - Friday @ 3:00pm to 3:40pm
Second Grade - Friday @ 3:50pm to 4:30pm

2021 Soccer Class Tuition (9 Classes Total - October to December)

Price: $ 149.00

Monday Classes: Oct. 4, 18, 25; Nov. 1, 8, 15, 22, 29; Dec. 6 // Friday Classes: Oct. 1, 8, 15, 22, 29; Nov. 5, 19; Dec 3, 10

Credit Card Number

Expiration Date

CCV Number

Parent/Caregiver Name *

Mailing Address *

City *

State *

Zip Code *

Email *

Alternate Email

Mobile Phone *

Work Phone

Home Phone

Emergency Contact Name *

Emergency Contact Phone *

Does your child have ANY medical condition or allergy that we need to know about, particularly any condition that may impede breathing (like asthma, food allergies, reactions to bug bites, etc)? *

Describe Condition Here (All information is kept confidential) *

Is your child required to take ANY type of over-the-counter or prescription medication, including but not limited to inhalers, breathing treatments, or rescue-aids like an epi pen? *

Describe Medication Here (All information is kept confidential) *

I understand my child will be responsible for following all mandated Covid-related safety procedures while participating in TSLC activities. Non-compliance in any way will result in immediate expulsion and forfeiture of all fees paid. I understand that due to Covid restrictions, there will be no makeups, credits or refunds for any reason including weather related cancellations, school closures, COVID restrictions, etc: *

I agree. Continue on to sign waiver.
I don't agree. Please cancel my registration.

READ THIS WAIVER CAREFULLY. TO CONFIRM, CLICK AGREE, SIGN & DATE BELOW: By clicking on "I agree" and signing my name below, I certify I am the parent/legal guardian of the above registered player who wishes to participate in soccer related activities at The Soccer Learning Center (referred to as Activity). I have disclosed any pertinent medical information in this document and certify that my child has been cleared by their healthcare provider to participate in The Soccer Learning Center Activity. I certify that I/my child will follow all staff directions related to all safety procedures in place at the time of this Activity including COVID-19 policies that cover proper mask wearing, hand sanitization, social distancing, temperature checks and any other procedure or practice necessary as recommended by the CDC and health department guidelines. I understand that if my child is unwell he/she should not attend any TSLC Activity. I understand that personal information may be required to be distributed to contact tracers or the local health department per their directives. I also certify that my child is of the required class age and understand that if I do not produce documents verifying their age if necessary, they will be removed from class and I will forfeit 100% of my tuition. I acknowledge that the nature of the classes at The Soccer Learning Center may expose my child to hazards or risks that may result in illness, personal injury or death. I understand and appreciate the nature of such hazards and risks. In consideration of my child's participation in the Activity, I hereby accept all risk to my child's health and of their injury/illness that may result in such participation and I hereby release Team Raja, LLC DBA The Soccer Learning Center, Primary Prep, it officers, employees, and representatives from any liability to me, our personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to our property and for any and all illness or injury to my child that may result from or occur during their participation in the Activity, whether caused by negligence of Team Raja, LLC, Primary Prep, its officers, employees or representatives or otherwise. I further agree to indemnify and hold harmless Team Raja, LLC, Primary Prep, its officers, employees, and representatives from liability for the injury of any person(s) and damage to property that may result from any negligent or intentional act or omission while my child participates in the described Activity. I understand that once I register for this Activity, I have reserved a space that is non-refundable for any reason. I understand that if I dispute this policy and try to reverse a valid merchant charge or check with my banking institution, The Soccer Learning Center reserves the right to file collection and/or legal actions to ensure the recovery of the disputed tuition amounts plus all applicable fees and damages including charges for the time required to dispute and adjudicate such claims. If you have any questions, we encourage you to call The Soccer Learning Center at 201-656-1156 or email us at CoachAlex@SoccerLearningCenter.com. (copy) *

I agree to all waiver terms.
I do not agree, please cancel my registration.

Parent/Caregiver's Electronic Signature *

Date (mm/dd/yyyy) *

Phone

The Area's Best Indoor Co-Ed Soccer Program for Adults

Mailing Address

The Soccer Learning Center
P.O. Box 1152 Secaucus, New Jersey 07096-1152

Office: (201) 656 - 1156
Coach Alex Lalaoui: (201) 920-8523
Fax: (201) 839-9886
CoachAlex@SoccerLearningCenter.com

Adult Program Registration

Children's Program Registration

Locations

Outdoor @ Shetik Field
225 County Avenue
Secaucus, NJ 07094

Free parking on site

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Indoor @ Humboldt Gym
123 Centre Ave
Secaucus, NJ 07094 (Side Door Entrance)

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