SBD School Holiday Clinic Enrolment Form

1
School Holiday Clinic - Reynella East College* This field is required.08:30AM - 12:00PM (7-15 years)
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$20
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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School holiday clinic - Tuesday 15th December
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School holiday clinic - Wednesday 16th December

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School holiday clinic - Thursday 17th December
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School holiday clinic - Tuesday 5th January
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School holiday clinic - Wednesday 6th January

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School holiday clinic - Thursday 7th January
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School holiday clinic - Friday 8th January
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Total cost
Debit or Credit Card
2
Player Name* This field is required.
First Name
Last Name
3
Date of Birth* This field is required.
Date
Day
Month
Year
4
Current Age* This field is required.
5
Gender* This field is required.
Male
Female
6
Previous playing experience* This field is required.
No experience
Academy
Federation
Club
School
Other
7
How many years of experience does the player have?* This field is required.
8
At which academy/club/school did the player gain this experience?* This field is required.
9
Does the player have any pre-existing medical conditions* This field is required.
10
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)
YESNO
11
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.(If you select No, please confirm in writing via email to accounts@soccerbydesign.com.au)
YESNO
12
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.(If you select No, please confirm in writing via email to accounts@soccerbydesign.com.au)
YESNO
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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
Todays Date
Date
Day
Month
Year
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