Powerchair Football Program Registration Form

Powerchair Football Program Registration Form
This form is for players of all ages with a disability who wish to participate in Capital Football's Powerchair Football program.

Powerchair Football training is run during school terms. It is held on a Saturday from 10am - 12.30pm at Gold Creek High School (Nicholls District Playing Fields parking off Clarrie Hermes Dr, Nicholls)
Participant Full name

First NameLast Name
Participant DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardians Name

First NameLast Name
Parent/Guardians Email
example@example.com
Parent/Guardians Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Any further information we should be aware of?
Should be Empty: