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24
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1
Name
First Name
Last Name
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2
Date of Birth
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3
Age
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4
Gender
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Male
Female
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Male
Female
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5
School
(Optional)
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6
Name
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Last Name
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7
Relationship to player
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8
Mobile number
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9
Email address
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10
Name
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11
Relationship
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12
Contact number
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13
Does your child have any known medical conditions?
YES
NO
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14
If yes, please specify:
Medical conditions (e.g. asthma, allergies, epilepsy) Medications carried (e.g. inhaler, EpiPen) Previous or current injuries Any limitations the coach should be aware of
This information is confidential and used only to ensure player safety.
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15
Current club (if any)
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16
Playing experience (years)
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17
Preferred position(s)
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18
Has your child had private coaching before? (Yes/No)
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19
Tick or short response:
Ball Mastery
1v1 skills
Finishing
Confidence
Game awareness
Fitness & Fundamental movement skills
Other
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20
Please tick to confirm:
I give permission for my child to participate in private coaching sessions
I consent to emergency medical treatment if required
I understand sessions involve physical activity and accept inherent risk
I consent to photos/videos being taken for coaching or promotional purposes
I understand the cancellation & refund policy
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21
Name
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Last Name
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22
Signature
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23
Date
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24
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ORDER SUMMARY
Total cost
AUD
Player Development Programme - 10x Sessions
10-session coaching package designed to improve skills, technique, and performance.
$
350.00
AUD
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