CLUBMAX COACHING: Parent Application Form

  
 
For only $39.95 per year, parents now have the ability to help their children with home training via access to the Video Training Center on the ClubMax web site. No soccer experience necessary.
 
Contact Information
Soccer Club Name:
Parent's First Name:  
Parent's Last Name:  
Address:

City:
State:
Zip:
Email:  
Daytime Phone:
Evening Phone:
     
Parent Membership ($39.95 per year)

Choose a Parent's User Name and Password
Parent User Name:  
Parent Password:
 
Please select your preferred form of payment
By Check

I am submitting this form electronicaally and will mail a check payable to ClubMax Coaching to 58 hawks Hill Road, New Canaan, CT 06840. I understand my access with be initiated upon receipt of the check.
 
Amount I am sending by mail:
 
Check Number:
 
Date Check Sent:
 
By Charge
 
Account number on card:
Expiration date on card:
Name as it appears on your card:
 

Please note: All online information from this form is handled by a secure server.
   
 

Upon subscribing, ClubMax Coaching™ will contact you directly to confirm your subscription.
 

Home

For more information call us at 203.966.8081
or email ClubMax™ Coaching now at
davejohnson@clubmaxcoaching.com

© 2005 Five Star Holdings, LLC

Return to top