Highlands FC & SE Phoenix Women’s FC Academy Girls Only Football Clinic
Commencing Monday 19th April 2021 Renwick School, Mittagong, 5.30pm-6.45pm
Player Name
*
First Name
Last Name
Player Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
Please provide details of any health issues of the player we should be aware of (leave blank if no health issues)
*
Please enter details otherwise leave blank
Parent/Carer Details
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Postal Address if Different to Home Address
Parent/Carer Telephone Number
Please enter a valid phone number.
Parent/Carer Email
example@example.com
Program
Under 8 and/or Under 9
Under 10 to Under 12
Other ?
Duration
Length of Program (i.e. 20 weeks)
Term Program (i.e. 10 weeks)
Short Program (i.e. 5 weeks)
Payment to
ANZ BANK
NB COACHING
BSB: 012 709
ACC: 641105881
with player's name as the reference.
Any Enquiries to Norm Boardman norm@sephoenixfc.com.au or 0407037883
Submit
Should be Empty: