Expression of Interest – Perth Elite Futsal (Lakelands SHS)
Register your interest in joining the Perth Elite Futsal program at Lakelands Senior High School. Please complete the form below.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Gender
*
Male
Female
Other
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Medical Conditions (if any)
Previous Futsal/Soccer Experience
*
Consent to Participate
*
I give consent for the participant to take part in the Perth Elite Futsal program.
Additional Comments
Submit Expression of Interest
Should be Empty: