New or Returning Client *

Last Name *

Date of birth *

Phone *

Email *

First Name *

Address

Street Address *

City

Province

Country

Postal code

Parent/Guardian Name *

Parent/Guardian Phone # *

Parent/Guardian Email *

Male or Female? *

Male

Female

How many years of experience do you have? *

What team/club do you play for? *

What are your goals? What can Football Lab help you accomplish? *

What are your strengths? *

What are your weaknesses? What do you feel like you need to work on? *

Emergency Contact Name *

Emergency Contact Phone # *

Emergency Contact Relation To Player *

Do you take any medications? *

Payment and Package Options

Please note that 5%GST price is reflected below

1 Month | 2 Sessions Weekly: 532 +5% = $558.60

1 Month | 3 Sessions Weekly: ~~$748~~ $676+5% = $709.80

2 Months | 2 Sessions Weekly: ~~$964~~ $804+5% = $844.20

2 Months | 3 Sessions Weekly: ~~$1396~~ $1160 +5% = $1113.00

Payment Method *

Credit Card Payment *

Summer Program 1 Month 2 Sessions

CA$532

Summer Program 1 Month 3 Sessions

CA$748

CA$676

Summer Program 2 Month 2 Sessions

CA$964

CA$804

Summer Program 2 Month 3 Sessions

CA$1396

CA$1060

Package Duration *

Sessions per Week *

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