Toddler Footy Clinic Application
TERM 2 BEGINS
Saturday 6th May for 7 weeks - $75
Child's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Post Code
Child's DOB
*
/
Day
/
Month
Year
Date
Best contact Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Parent's Name
*
First Name
Last Name
Any medical conditions/ allergies
What age group are you registering for?
*
SATURDAY 2-4 years (8am - 8.30am)
SATURDAY 4-5 years (8.35am - 9.10am)
I, parent/ guardian, in the event of an injury or illness to my child, authorise the organisers to seek medical assistance on my behalf. Organisers will not be liable for loss, damage or injury, to property or person occasioned as a consequence of enrollment in TODDLER FOOTY CLINIC, and I acknowledge the exclusion of liability accordingly
*
I have read and agree to the above
I agree to the following - I give permission for my child to be photographed whilst participating in this program and understand photos may be used for marketing material
*
I have read and agree to the above
No refund will be given for non attendance
*
I have read and agree to the above
Submit
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