SBD Goalkeeper Sessions Enrolment Form

1
Goalkeeper SessionsHeld at Reynella East College
Please Select
Friday 5-6 PM
2
Do you consent to your child being photographed or recorded for use in Soccer By Design’s promotional materials, including social media and our website?* This field is required.(If you select No, please confirm in writing via email to accounts@soccerbydesign.com.au)
Please Select
Please Select
YES
NO
3
Do you consent to Soccer By Design seeking medical treatment for your child, including calling an ambulance if required, and accept responsibility for any associated costs?* This field is required.
Please Select
Please Select
YES
NO
4
I understand that participation in soccer and related activities involves a degree of risk and agree that Soccer By Design, its staff, and volunteers are not liable for any injury, loss, or damage, except where required by law.* This field is required.
Please Select
Please Select
YES
NO
5
Player Name* This field is required.
First Name
Last Name
6
Date of Birth* This field is required.
Date
Day
Month
Year
7
Current Age* This field is required.
8
Gender* This field is required.
Male
Female
9
Previous playing experience* This field is required.
No experience
School
Club
Federation
Other
10
How many years of experience does the player have?* This field is required.
11
At which school/club did the player gain this experience?* This field is required.
12
Does the player have any pre-existing medical conditions* This field is required.
13
Parents Name* This field is required.
First Name
Last Name
14
Phone Number* This field is required.
15
Email* This field is required.
example@example.com
16
Date
Date
Day
Month
Year
Should be Empty: