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Indian Community Football Gala Day Registration Form
1
Name
*
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First Name
Last Name
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2
Age
*
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3
Gender
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
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4
Email
*
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example@example.com
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5
Phone Number
Area Code
Phone Number
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6
Postcode
*
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7
Please select which of the following Come and Try activities you would like to participate in?
*
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Walking Football session - for any one
PlayHer session - women and girls only
Social small-sided games - for any one
None
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8
Do you have additional family members who would like to attend the Gala Day?
*
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YES
NO
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9
How many additional family members are you registering for?
One
Two
Three
Four
Five
Six or more
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10
Details of family member one
First Name
Surname
Age - Please enter a number
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Please Select
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Gender
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Please Select
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Which of the following Come and Try activities would they like to participate in?
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11
Details of family member two
First Name
Surname
Age - Please enter a number
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Please Select
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Gender
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Please Select
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Which of the following Come and Try activities would they like to participate in?
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12
Details of family member three
First Name
Surname
Age - Please enter a number
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Please Select
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Gender
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Please Select
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Which of the following Come and Try activities would they like to participate in?
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13
Details of family member four
First Name
Surname
Age - Please enter a number
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Please Select
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Gender
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Please Select
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Which of the following Come and Try activities would they like to participate in?
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14
Details of family member five
First Name
Surname
Age - Please enter a number
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Please Select
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Gender
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Please Select
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Which of the following Come and Try activities would they like to participate in?
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15
Details of family member six
First Name
Surname
Age - Please enter a number
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Please Select
Please Select
Male
Female
Non-binary
Prefer to self-describe
Prefer not to say
Gender
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Please Select
Walking Football session - for any one
PlayHer session - woman and girls only
Social small-sided games - for any one
None
Which of the following Come and Try activities would they like to participate in?
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16
Do you consent to being photographed and filmed by Football Victoria at this event, with images and footage potentially used on social media?
*
This field is required.
YES
NO
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