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Islamic Center of Staten Island

365 VETERANS RD W, Staten Island, New York 10309, USA

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Lions Soccer Clinic Winter 2025

16
FEB

1:00 PM

09
MAR

5:00 PM

Program Fee:

One Time: $120.00

Offering Days: Sunday

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

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Child's Full Name (First , Last) *

Child's DOB (MM/DD/YYYY) *

Child's Grade in School (upto 8th grade) *

Parents Full Name (First, Last) *

Parent Phone Number *

Has your child played for ICSI Lions before?*

Comments

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3 Lions Soccer Clinic Winter 2025

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

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Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Islamic Center of Staten Island consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Since you purchased free Ticket No Payment Required.

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Payment Summary

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Total Registrants

Total Cost

Islamic Center of Staten Island

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Lions Soccer Clinic Winter 2025

1 Contact Information

2 Add Registrants

3 Lions Soccer Clinic Winter 2025

Payment Summary

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