Elite Football Female Program 2022
Payment method: Online card payment (No cash payments)
Email
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example@example.com
Child Full Name (If buying programs/packages for multiple children, please fill out individual separate forms for each of them)
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First Name
Last Name
Child date of birth
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Day
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Month
Year
Date
Parent Full Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Address
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Street Address
Street Address Line 2
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Please select which packages you would like to purchase below:
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Categories:
All
All
Junior Program
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Trail Session Female Program
Chose a Day: Saturdays 9am, Saturdays 10am or Wednesdays 4.30pm. 60 min sessions.
$
Free
AUD
Saturday 9AM
Wednesday 4.30PM
Junior Program
Term 3 2022 Female Program - Starts 16th of July
Starts 16th of July - Training once a week. Days: Saturdays 9am, Saturdays 10am or Wednesdays 4.30pm. 60 min sessions. 5 sessions remaining
$
Free
AUD
Time slot:
9AM Saturdays
10AM Saturdays
4.30PM Wednesdays
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Emergency secondary contact
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First Name
Last Name
Emergency secondary contact number
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Please enter a valid phone number.
Medical History: Does your child suffer from any Allergies/Illnesses?
*
No
Yes - (please specify below)
Medical History: Is your child on any Medication?
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No
Yes - (please specify below)
Does your child have any other injuries or physical difficulties suffered in the past or present:
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No
Yes - (please specify below)
Authority to Seek Medical Assistance: In case of Emergency I/We authorise the General Manager or Qualified coach of Elite Football to seek Medical Assistance or Ambulance for myself or my child/children & agree to pay all cost incurred. (Please tick below)
*
Yes
Authority to Use Still & Video Content for Advertising Purposes: I give permission for any photos or videos of my child to be used on all platforms of social media eg: Facebook, Instagram, Twitter and Elite Football Centre website and any other as deemed appropriate. (Please tick below)
*
Yes
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