"2023 Pirates Summer Program" Registration Form
Register for the Summer program below:
Player Name
*
First Name
Last Name
Date of Birth
*
/
Day
/
Month
Year
Date
Players Age in 2023
*
Please Select
4
5
6
7
8
9
10
11
12
FFA/DRIBL No:
Football Identification number if applicable
Club Played 2023
*
Previous Club if played before if not put N/A
Division in 2023
*
Level played if played before if not put N/A
Suburb you live*
*
Name of School
*
Parent Name
*
First Name
Last Name
Parent E-mail
*
example@example.com
Parent Mobile
*
-
Area Code
Mobile Number
Pirates 8 weeks Summer Program
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Tuesday Package
$150.00 AUD
$
150.00
AUD
8 Week training with qualified coaches. Commencing Tuesday 17th October - 05th December at 5.00pm for 4 - 12 years of age at Hammond Park. Each session is for approx. 60 minutes.
Quantity
1
2
3
4
5
6
7
8
9
10
Thursday Package
$150.00 AUD
$
150.00
AUD
8 Week training with qualified coaches. Commencing Thursday 19th October - 07th December at 5.00pm for 4 - 12 years of age at Hammond Park. Each session is for approx. 60 minutes.
Total
$0.00 AUD
$
0.00
AUD
Active Kids Voucher Number
You MUST email a copy of voucher
Pirates Bank Account details:
Account Name: Ashfield Pirates FC BSB: 082-338 Account number: 989171847 Once payment made in full please send through a copy of the payment to info@piratesfc.com.au. Active kids voucher will be redeemed on your behalf and refunded to you with in 14 days.
Comments
Any additional information about your child.
Submit
Should be Empty: