Northern Stars Football Academy Registration Form

Which location

You will need to fill out one registration per player.

Players Name

First NameLast Name

Birth Date

MonthDayYear

Male/Female

Parent/Guardian Name

First NameLast Name

Address

Street Address

Street Address Line 2

SuburbState

Post Code

Phone Number

Mobile Number

E-mail

Emergency Contact

First NameLast Name

Phone Number

Mobile Number

Medical Concerns

Current Club

Position(s) Played

Years of Playing Experience

Previous Coaching (if applicable):

At Northern Stars Football Academy we aim to provide a safe, enjoyable and positive experience for all participants. During the sessions, we would sometimes like to take photos and film some of the sessions. Sometimes we may use these for publicity, marketing and social media. In the interests of safeguarding and the player’s welfare we are asking for your permission to take photos/video footage.

Do you consent to allowing images of your child on our socials?

By submitting this form, I, as the parent/guardian of the registrant, consent to emergency medical treatment being administered by a registered medical practitioner or dentist, as deemed necessary to protect the registrant’s life, health, or well-being.

By submitting this form, I, the parent/guardian of the registrant, who is a minor, agree to adhere to the rules and regulations of the Northern Stars Football Academy, including its affiliated organisations and sponsors. I acknowledge the potential risks of physical injury associated with soccer and, in consideration of the Northern Stars Football Academy accepting the registrant into its soccer programs and activities (the "Programs"), I hereby release, discharge, and indemnify the Northern Stars Football Academy, its affiliated organisations and sponsors, their employees, and associated personnel, including the owners of any fields and facilities used for the Programs. This release covers any claims made by or on behalf of the registrant arising from participation in the Programs or during transportation to or from the Programs, which I authorise.

Type a question

Northern Stars Football Academy BSB 084970 Account 238099944 Reference: Player Name

Payment option

PARENT/GUARDIAN INFORMATION:

Northern Stars Football Academy Player Registration

PLAYER INFORMATION:

MEDICAL INFORMATION

Football Experience

Photograph and Video Disclaimer