Kixx Football Academy - Registration Form

Medical Information
YesNo
If yes, please provide details. (Ex: Allergies/ Asthma/ Injuries etc.)
Are you currently under medication? *
Please provide the details, the name of the medication and period of intake

Parent/ Guardian/ Spouse Contact Information
Name*

First NameLast Name
Relation*
Contact Number*

Country CodeArea CodePhone Number
Disclaimer & Release of Liability

To the best of my knowledge, I am in good physical health and fully capable of participating in the Kixx Football Academy sessions. I acknowledge that participation in the academy involves physical activities that carry a potential for injury. I assume full responsibility for any risks of injury, loss, or property damage that may occur as a result of my participation.

I hereby release the Kixx football Academy, its coaches and employees from any claims or liabilities for injuries or damages that I may sustain as a result of participation in the program. I have read and fully understood this Disclaimer and Release of Liability and voluntarily agree to its terms.
I, student agree to the above disclaimer and consent my participation in the academy's training sessions.

Fee Structure & Payment
Weekly Individual Training - LKR. 14,000Bi-weekly Individual Training - LKR. 14,000Weekly Group Training - LKR. 8,000Bi-weekly Group Training - LKR. 26,000Weekly Personal Outdoor Training - 12,000Weekly Outdoor Group Training - 10,000
Admission Fee: LKR 6,000

The admission fee is a one time payment that includes the cost of a Kixx Football practice kit. If you need to purchase an additional kit, it will be available for an additional cost of LKR. 4,500.

Per Session Fee: LKR. 2,700 (1 hour)
To complete the registration, please make the payment of the admission and the fee to the bank account below, and kindly attach the bank slip.

Account: Mr. Nizam Mohamed Nabeel
Account Number: 1000708767
Bank: Commercial Bank
Branch: Kayzer Street

All fees must be paid on or before the 10th of each month. Failure to do so will result in a 15% late fee applied to all payments.

IMPORTANT:

Please note that the monthly fee includes four (4) sessions. Absences from these sessions will not be accommodated seperately, unless a session is rescheduled by the Kixx management. In such instances, you will have the option to attend the reshceduled session. However, sessions missed due to personal reasons cannont be rescheduled or compensated for in subsequent weeks.
Please attach the online/ bank payment slip here.
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