Term 4 Victory Intermediate Academy program

Victory Intermediate Academy Program

10 weeks per term, starting on 13th October 2025.
Participation Information
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Gender
Parent/Guardians Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Information
Medical Conditions
Does the child have any illnesses, allergies, medical conditions or special needs?
In the event of an emergency & you are unreachable, do you give us permission to contact an Ambulance service?*

YesNo
Payment
Prefer payment type*

Credit cardDirect bank deposit
Choose Options

1 training per week - $3552 training per week - $5653 training per week - $675
Do you need to purchase a uniform?*

Yes - $85 (Jersey, Shorts & Socks)No - Existing player
Bank Details

Bank: Commonwealth Bank

Name: Sydney Victory Football Academy

BSB: 062268

Account: 10447295

Reference: Child's name
Credit card Payment
prevnext( X )
1 training per week$355 + Merchant fee
$361.65AUD



2 training per week$565 plus Merchant fee
$575.35AUD



3 training per week$675 plus Merchant fee
$687.30AUD



Purchase uniform$85 plus Merchant fee
$86.60AUD



Total

$0.00AUD
Should be Empty:

Victory Intermediate Academy Program