PRIMAVERA ACADEMIA SKILLS ACQUISITION CLINIC
Players Name
*
First Name
Last Name
Parents Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parents Email
*
example@example.com
How does the player identify
*
Female
Male
Other
Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
What is your current age group that you play for Club/Academy?
*
Please Select
U8
U9
U10
U11
U12
U13
U14
U16
U18
Where do you currently play?
*
Club Level
Full time Academy Player
Which sessions do you wish to attend?
*
Saturday 13th June
Saturday 20th June
Saturday 27th June
Saturday 4th July
Saturday 11th July
Saturday 18th July
Video and photo consent question
*
Yes
No
Does the player have a medical condition that we have to be aware of?
*
No
Yes
What is the medical condition and what do we need to know?
*
Submit
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