Manningham United FC — June Holiday Camp
· Petty's Reserve · Monday 29th & Tuesday 30th June · 9:00am – 1:00pm · $95 per day · $175 for both days ·
How many children are you registering?
*
1
2
3
Parent / Guardian Details
Parent / Guardian Full Name
*
First Name
Last Name
Mobile Number
*
Please enter a valid phone number.
Format: 0000000000.
Email Address
*
example@example.com
Home Suburb
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Mobile
*
Please enter a valid phone number.
Format: 0000000000.
Relationship to Children
*
Child 1
Player first name
*
Player last name
*
Date of birth
*
-
Month
-
Day
Year
Date
Goalkeeper or outfield
*
Goalkeeper
Outfield
Days attending
*
Monday only — $95
Tuesday only — $95
Both days — $175
Current club / team
Any medical conditions?
*
Yes
No
List medical conditions
Any allergies (food/insect/other)?
*
Yes
No
List allergies
Carries an EpiPen?
*
Yes
No
Asthma?
*
Yes
No
Inhaler carried?
Yes
No
Child 2
Player first name
*
Player last name
*
Date of birth
*
-
Month
-
Day
Year
Date
Goalkeeper or outfield
*
Goalkeeper
Outfield
Days attending
*
Monday only — $95
Tuesday only — $95
Both days — $175
Current club / team
Any medical conditions?
*
Yes
No
List medical conditions
Any allergies (food/insect/other)?
*
Yes
No
List allergies
Carries an EpiPen?
*
Yes
No
Asthma?
*
Yes
No
Inhaler carried?
Yes
No
Child 3
Player first name
*
Player last name
*
Date of birth
*
-
Month
-
Day
Year
Date
Goalkeeper or outfield
*
Goalkeeper
Outfield
Days attending
*
Monday only — $95
Tuesday only — $95
Both days — $175
Current club / team
Any medical conditions?
*
Yes
No
List medical conditions
Any allergies (food/insect/other)?
*
Yes
No
List allergies
Carries an EpiPen?
*
Yes
No
Asthma?
*
Yes
No
Inhaler carried?
Yes
No
Consent & Policies
Consent to participate in physical football / goalkeeper training activities
*
I consent
Authorisation for camp coordinator to seek medical treatment in an emergency if I cannot be reached
*
I authorise
Consent to use photos or video to promote Manningham United FC and Hattrick FC
*
Yes
No
Acknowledgement that registration fees are non-refundable, including for no-shows
*
I acknowledge
Acknowledgement that participation carries inherent physical risk
*
I acknowledge
Total
*
Payment Amount
*
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( X )
AUD
Description
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Register & Pay
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