Northern Stars Champions League Registration Form

Northern Stars Champions League Player Registration

Expression of Interest
Which location
You will need to fill out one registration per player.
PLAYER INFORMATION:
Players Name

First NameLast Name
Birth Date

MonthDayYear
Male/Female
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

SuburbState

Post Code
Phone Number
Mobile Number
E-mail
MEDICAL INFORMATION
Emergency Contact

First NameLast Name
Phone Number
Mobile Number
Medical Concerns
Football Experience
Current Club
Position(s) Played
Photograph and Video Disclaimer
At Northern Stars Football Academy we aim to provide a safe, enjoyable and positive experience for all participants. During the sessions, we would sometimes like to take photos and film some of the sessions. Sometimes we may use these for publicity, marketing and social media. In the interests of safeguarding and the player’s welfare we are asking for your permission to take photos/video footage.
Do you consent to allowing images of your child on our socials?
Payment Details
Once teams and schedule have been produced, details will be sent to all registered players/parents and payment will be required in full. We will be using the Tournify app to keep parents/players up to date with fixtures, ladders and finals series. Cost is $125 Per Player for 8 week competition.

To secure your spot, please deposit $125 into the following bank account:

Account Name: Northern Stars Football Academy

BSB: 084970

Account Number: 238099944

Reference Number: Players Full Name
By submitting this form, I, as the parent/guardian of the registrant, consent to emergency medical treatment being administered by a registered medical practitioner or dentist, as deemed necessary to protect the registrant’s life, health, or well-being.

By submitting this form, I, the parent/guardian of the registrant, who is a minor, agree to adhere to the rules and regulations of the Northern Stars Football Academy, including its affiliated organisations and sponsors. I acknowledge the potential risks of physical injury associated with soccer and, in consideration of the Northern Stars Football Academy accepting the registrant into its soccer programs and activities (the "Programs"), I hereby release, discharge, and indemnify the Northern Stars Football Academy, its affiliated organisations and sponsors, their employees, and associated personnel, including the owners of any fields and facilities used for the Programs. This release covers any claims made by or on behalf of the registrant arising from participation in the Programs or during transportation to or from the Programs, which I authorise.
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Northern Stars Champions League Player Registration

PLAYER INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION

Football Experience

Photograph and Video Disclaimer

Payment Details