Secure Order Form

 Accepted

 CUSTOMER BILLING INFORMATION
First Name:  
Last Name:  
Address 1:  
Address 2:  

City, State:

                                        
Zip code:  

Phone:

(333-444-5555)

  
Emergency Phone:  
Fax:  
Email Address:  

 STUDENT ATHLETE INFORMATION
Please Fill this Section out with the Information about the student who will be attending the

clinic at Play Like A Pro.  For Dodge Ball Sign-ups, please give us the names of the players on your team under (Misc. Information)
First Name:  
Last Name:  
Age:  
Birthday:          
Grade in school:  
Email:  
Sport(s) Played:  
     
Misc. Information:  
     
Shirt Size:   *Required for Soccer League Only
Previous Soccer Experience:   *Required for Soccer League Only
If YES above, what league or level played:   *Required for Soccer League Only

Is the parent willing to be

a volunteer head coach:

   *Required for Soccer League Only

Is the parent willing to be

a volunteer assistant coach:

   *Required for Soccer League Only

 WHICH CLINIC ARE YOU INTERESTED IN PURCHASING?

 This is the amount your credit card will be charged. (Including Tax)

LITTLE SLUGGERS PROGRAMS

 

SPORTS BASH CAMPS & CLINICS

 

SUMMER CAMPS

 

OPTIONAL LUNCH PROGRAM (FOR SPORTS BASH SUMMER CAMP ONLY)

 
     
Enter Discount Code:  

For Single Day Camps,

Please specify which day you will be attending:

  
 

CUSTOMER PAYMENT INFORMATION. 

**Please Note, The Credit Card you provide must match the billing address stated above.  For any questions, please contact us anytime.
Credit Card Type:  
Credit Card #:   (Enter without spaces)
Name on the Card:  
Expiration Date:                                                                               
3/4 Digit Security Code:  
     
How did you hear about us?  

 

This Form will be sent directly to a sales representative to be processed right away. 

If  there is any problems, you will be contacted shortly.  Play Like a Pro Baseball does not

disclose your information to third parties.

 

PLEASE NOTE! By clicking the submit button below, you agree that if in any case you wish to

cancel the requested clinic, $50 will be with held from the amount refunded to you as long as

your cancellation notice is received prior to 10 days before the clinic is to begin. 

Any student wishing to cancel a clinic within 10 days prior to the clinic being started

will not receive any refund or credits.