Future Futsal Registration Form

1

Player's Name* This field is required.

First Name

Last Name

2

Player's Date of Birth* This field is required.

Date

3

Select Program* This field is required.

Monday program

Sunday program

4

Select Membership Pass* This field is required.Please pay to Club Account: FUTURE FUTSAL INC BSB: 633-000 Account: 139384598 Please include your player's full name in the transaction description. * Season passes are offered until May of each calendar year

Term Pass ($150)

Double Term Pass ($250)

Season Pass ($450)

Double Season Pass ($700)

5

Parent/Guardian NameFor player's under 18

First Name

Last Name

6

Mobile Phone* This field is required.

7

Email Address* This field is required.

example@example.com

8

Suburb* This field is required.

9

Medical conditionsPlease advise if player suffers from any medical condition or on any medications for which we should be made aware of?

10

Signature* This field is required.Please Note: Future Futsal accept no responsibility for treatment of any medical conditions a player may suffer from whilst in our care. Though Staff and Coaches apply necessary safety measures, there may be inherent risks associated with participating in sport that may result in personal injury. Although FV affiliated, Future Futsal and its staff accept no liability for injuries sustained by the player whilst in our care. I/We hereby consent to the player attending Club Future Futsal activities in accordance with the terms outlined above.

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