$50.00
Student's First Name: Student's Last Name:
Student's Birthdate:
Student's Age (as of September 1, 2020):
Parent's First Name: Parent's Last Name:
Address:
City: State: Zip Code:
Home Telephone:
Daytime: (Work/Cell)
Parent/Guardian Email:
Student's Email (if applicable):
Emergency Contact Name:
Emergency Contact Number:
Emergency Contact Relationship to Student:
Offered Daily, Monday - Friday, 2:30pm-6pm
1 Day/Week ($40 Weekly)2 Days/Week ($75 Weekly)3 Days/Week ($100 Weekly)4 Days/Week ($135 Weekly)5 Days/Week ($170 Weekly)
*Sibling Discount: 2nd Child 10% discount; each additional child, 5% discount
Check the Days that you would like to enroll:
MondayTuesdayWednesdayThursdayFriday
I would like to have my child picked up from school.My child will not require transportation.
School Name:
LST Terms and Conditions Relating to Code of Conduct, Liability, and Facility Protocols
I have read and agree to the Loudoun Sports Training Terms and Conditions