Holiday Program - Canterbury
Lees Park
Participant Full Name
*
First Name
Last Name
Date Of Birth
*
-
Day
-
Month
Year
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?
*
Yes
No
My Products
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( X )
1 Day
$
60.00
AUD
Black Hat
$
16.00
AUD
White Hat
$
16.00
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
If your child is not attending both days, please list the day your child will be attending
How did you hear about the MT Football Holiday Program?
Referred by a friend
Facebook / Instagram
Returning player
SUBMIT
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