TEAMS Registration

Student Information:

Student's First Name: Student's Last Name:

Student's Birthdate:

Student's Age (as of September 1, 2017):

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:

T.E.A.M.S. After School Program Tuition Fees

Offered Daily, Monday - Friday, 2:30pm-6pm

I would like to enroll by child for:

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

T.E.A.M.S. Transportation - School Pick Up Information

I would like to have my child picked up from school.My child will not require transportation.

School Name:

Loudoun Sports Training Terms and Conditions

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