SAQ Registration Form
Student's Name: _____________________
Parents Name: ______________________
Age: _____ Birthday:__________________
Phone Number:______________________
Second Number:_____________________
Address:___________________________
City: ____________State: ____Zip:______
E-Mail:_____________________________
Choose a Class Time:_________________
Tuesday: 5:30 - 6:00 pm
Thursday: 5:30 - 6:00 pm
Student's Name: _____________________
Parents Name: ______________________
Age: _____ Birthday:__________________
Phone Number:______________________
Second Number:_____________________
Address:___________________________
City: ____________State: ____Zip:______
E-Mail:_____________________________
Choose a Class Time:_________________
Tuesday: 5:30 - 6:00 pm
Thursday: 5:30 - 6:00 pm
Method of Payment
Check:___
Credit Card:___ Circle type of card
Visa, MC, Discover, AmEx
Card Number: ___________________
Expiration Date: __________________
Billing Zip Code: __________________
Name on Card: ___________________
Security Code: ___________________
Amount Authorize to charge: ________
Signature: _______________________
Date: ___________
Check:___
Credit Card:___ Circle type of card
Visa, MC, Discover, AmEx
Card Number: ___________________
Expiration Date: __________________
Billing Zip Code: __________________
Name on Card: ___________________
Security Code: ___________________
Amount Authorize to charge: ________
Signature: _______________________
Date: ___________
SAQ Speed, Agility, Quickness |
Hitters Row Baseball Academy 1901-D 50th Street LUBBOCK, TX 79412 (806) 749-8448 www.hittersrow.com |