
PARENTS OR GUARDIANS NAME(S)
ADDRESS
CITY PROVINCE
POSTAL CODE
HOME PHONE BUSINESS PHONE
AGE POSITION CLUB TEAM
COACH
COACH’S PHONE NUMBER
HEALTH CARD NUMBER EMAIL
ADDRESS
CIRCLE METHOD OF PAYMENT:
CHEQUE MASTERCARD VISA
CREDIT CARD NUMBER
EXPIRY DATE
NAME ON CARD SIGNATURE
100 The East Mall, Suite 11, Toronto, Ontario, Canada M8Z 5X2
Main Line: (416) 251-4625 x 32 Fax Line: (416) 251-7054 e-mail: lynx@lynxsoccer.com
* The Toronto Lynx reserve the right to cancel or alter dates of sessions as required.