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Gosal Futsal Registration Form for Kosal Social Futsal - January 2026
Thursday 4th & 11th December 6:30 to 8:00pm at Nga Puna Wai
Full Name (First and Last Name)
*
Email
*
Mobile Number
*
Have you registered for Gosal Kosal Futsal before?
Yes
No
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Date of Birth (must be 16 years and older)
*
-
Month
-
Day
Year
Date Picker Icon
Gender
*
Female
Male
Prefer not to say
Do you have any medical conditions?
*
No
Other
Emergency Contact Details
Emergency Contact Person Name
*
Emergency Contact Phone Number
*
Social Kosal
Position
*
Outfield Player
Goalkeeper
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Kosal Social Futsal Dates:
*
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Kosal Futsal 14th January 6:00 - 7:30 pm
Nga Puna Wai
$15.00 NZD
$
15.00
NZD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Term and Conditions
I/We understand that all fees must be paid in full prior to the start of each session and are non-refundable, except in cases where a session is canceled due to an insufficient number of registered players.
*
Yes
I/we give permission for Gosal Futsal and for the coaches to act on my behalf in an emergency if emergency contact cannot be reached. I also give consent to be attended to in an emergency, and that I have provided medical information in this form.
*
Yes
I/we hereby waive and release all coaches and staff from any liability for injuries sustained to my player whilst in attendance of the Gosal Futsal . I accept full responsibility for my medical bills and associated expenses as a result of injury or illness sustained whilst in attendance at the Gosal Futsal.
*
Yes
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