Player Registration Form
Enter the player’s details, parent/guardian contact info, emergency contact, and any medical considerations.
Player's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Name
*
First Name
Last Name
Club Experience
*
Cobram Junior Soccer Club
No prior soccer experience
Other club
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name and Number
*
Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Other
Medical or Physical Considerations
Cobram Roar is not liable for any injuries that occur during the sessions.
Participation in the Road to Roar Program does not guarantee Selection in the 2027 U12 teams
Club Bank Details BSB: 633-000 Account: 199961004 Account Name: Cobram Roar FC Reference Name and R2R
Register
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