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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
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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
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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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