Name: Peacock SCC Meeting
Start: 2019-11-18T18:00:00-06:00
End: 2019-11-18T19:00:00-06:00

Please fill out the form below to apply for the Prairie South Personalized Sport Training program.

50%

Please complete this program registration form in full.

As space is limited, the Personalized Sport Training committee will vet all registrations for acceptance into the program.
Your Name:*
First Last
Your Address:*
Street Address Address Line 2 City Province Postal Code
Date of Birth*
Enter in mm-dd-yyyy format
Date Format: MM slash DD slash YYYY
Full Name of Parent / Guardian:*
First Last
Phone Number (daytime):*
Enter your daytime phone number
Phone Number (cellular):
If you have a cellular phone number, enter it here
Your Email Address:*
Emergency Contact (other than parent):*
First Last
Grade you will be entering in the Fall semester:*
Enter the grade you will be entering in the Fall (September) semester