Registration Form
Player Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Parent/Guardians Name
First Name
Last Name
Address
City
E-mail
*
Phone Number
-
Area Code
Mobile
Participating in:
*
10 WEEK ACADEMY PROGRAM
SCHOOL HOLIDAY CLINIC
FOOTBALL TOURNAMENT
Trial
Age Groups
*
Mini (6-7)
Junior (8-9)
Junior Adv (10-11)
Youth (12-14)
Youth Adv (15-17)
Kit Size
*
6
8
10
12
XS
S
M
L
XL
Location
*
Lower Blue Mountains (Winmalee)
Sydney
Medicare Card Number
Street Address Line 2
City
State / Province
Postal / Zip Code
Does your child suffer from any of the following
*
Epilepsy
Heart Conditions
Asthma
Diabetes
Blackouts
Migraines
None
Allergies to
*
Penicillin
None
Is your child on any form of ongoing medication?, if so please state
Street Address Line 2
City
State / Province
Postal / Zip Code
What special care is recommeded?
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment Method
*
EFT/ Bank Transfer
Cash
Waiver
The undersigned in their capacity as parent/guardian of the above child acknowledges that they have read and understood the Terms & Conditions stated by One Goal Futbol and that this project is organised and managed by staff, and hereby waives any claim against One Goal Futbol, and their affiliated companies in connection with One Goal Futbol project he is being enrolled to.
Consent to Medical Attetion
Where the Coach or Club Management is unable to contact me, or it is impracticable to contact me, I hereby five permission to the Coach or Club Management to seek treatment for my child at a hospital, or to call a Doctor and/or ambulance and/or dentist during an emergency and agree to pay all relevant costs involved.
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Signature
*
Clear
Submit
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