Holiday Program - Canterbury

School Holidays

Lees Park - 10th & 11th July
Participant Full Name*

First NameLast Name
Date Of Birth*

DayMonthYear
Date
Parent Full name *
Email*
example@example.com
Mobile Number*
Suburb
Emergency contact 2 - Full name*
Mobile Number*
Does your child suffer from any medical conditions that might affect their participation?*
Do you give consent for your child to be filmed for social media content?*

YesNo
Prices (inclusive GST)

2 Days - $1101 Day - $60
If your child is not attending both days, please list the day your child will be attending
To make full payment, make a bank transfer to the account below.

BSB: 112-879

Account Number: 417 313 256

Account Name: MT FOOTBALL PTY LTD

Description: (Childs Full Name) & Canterbury HP
How did you hear about the MT Football Holiday Program?

Referred by a friendFacebook / InstagramReturning player
Should be Empty:

School Holidays