Child's Name:
Birthday:
Address:
State/Zip:
City:
Age:
Grade
One Time Fee
Includes...Full Uniform
and Insurance!
Impact Youth Soccer
then fill out complete Information below...then press 'Submit' button to complete registration!
1) PLEASE Click on Price
   to PAY/ Register...
Parent's Name:
Email Add:
Cell#: 
Please Note: If payment is not made...
$75.00
$75.00
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you are NOT registered!