Holroyd Rangers Academy Registration Form

Holroyd Rangers Academy

Term 1 - 2025 Registration Form
You will need to fill out one registration per child. At the end of the regsitration form you will need to make payment by direct deposit to the club account. Once you have completed the regsitration and payment you can start a new registration form for the next child.
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Sex*
I wish to join:*
Guildford West Sports Ground
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
E-mail*
PLAYING INFORMATION
Please Indicate Childs 2025 Club*
Preferred Position*
Highest Division Played*
Desired Outcome*
UNIFORM INFORMATION
Youth Jersey*
Youth Shorts*
Youth Socks*
MEDICAL INFORMATION
Medical Conditions - Please list any conditions we need to be aware of or that may affect participation
REGISTRATION PAYMENT
Please select one option below. Your child must be 5 years old by July 31, 2025 to register. You will need to provide a birth certificate for your child prior to collecting your uniform.
Sessions Per Week (10 Week {Term 1})*

1 session per week ($395)2 sessions per week ($495)
Please make payment BEFORE submitting as you will need your payment receipt number in the next step.
Forms submitted without payment will not be accepted and considered VOID. Use your childs full name + Academy as payment reference.

Pay to:

Holroyd Rangers Soccer Club

BSB: 032349

ACC: 582230
Payment Receipt Number*
Amount Paid*
By submitting the form, I, as the parent/guardian of the registrant, I hereby give consent for emergency medical care by NSW Paramedics or Doctors. This care may given under conditions necessary to preserve the life, limb, or well-being of registrant.

By submitting the form, I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Academy, its affiliated organisations and sponsors. Recognising the possibility of physical injury associated with soccer and in consideration for the Academy, accepting the registrant for its soccer programs and activities (the "Programs"). I hereby release, discharge and/or otherwise indemnify the Holroyd Rangers Academy, its affiliated organisations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilised for the Programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorise. I understand any missed sessions are at my own expense and these are neither refundable nor rescheduled. In the case that weather restricts training, sessions may be relocated to an alternate location.
Please verify that you are human*
Should be Empty:

Holroyd Rangers Academy

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

PLAYING INFORMATION

UNIFORM INFORMATION

MEDICAL INFORMATION

REGISTRATION PAYMENT