Grades K-thru-5

Drills & Scrimmages at Takoma Park Middle School field & gym
Director - Adrian Baez, Einstein varsity coach

Have Fun! Learn Soccer!

Half-day program (9 a.m. - Noon)
Monday - April 10th - thru - Friday - April 14th

First-come, first-served.  You will be sent an email with a full list of information. 
For questions contact Howard Kohn (kohn@erols.com).

Player's Name   Birth:    Grade    Gender

Names of Parents


Phone (home) (work)

E-mail address (important!)

Name & Number of Emergency Contact (during program week):

Medical Needs or Other Special Information:

I hereby give my child permission to participate in this soccer program.  I understand that no accident insurance is provided, and I agree that I will not hold Takoma Soccer or the Takoma Park Recreation Department responsible for any injury sustained while participating in this program.

Signature of Parent or Guardian ______________________________________________

Fee: $75 (Write checks to Takoma Soccer)
Mail to: Takoma Soccer, 16 Jefferson Ave, Takoma Park, MD 20912

NOTE: We need an original signature on the form.