Term 4 Goal Keeper Program
Thursday 15th October to Thursday 3rd December (2026)
Player Details
Child Name
*
First Name
Last Name
Child DOB
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Child Gender
*
Please Select
Male
Female
Club Played for in 2026
Age Group (2026)
Please Select
U6
U7
U8
U9
U10
U11
U12
Does your child have any medical conditions or pre-existing injuries? If yes, please specify.
*
Is there anything you would like coaches to know about your child? (not required)
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Parent / Guardian Details
Parent / Guardian Name
*
First Name
Last Name
Parent / Guardian Email
*
example@example.com
Parent / Guardian Phone Number
*
04XX XXX XXX
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Permissions
Do you provide a media consent for your child? (Photos on social media - Facebook/Instagram)
*
Yes, I provide a media consent for my child.
No, I do not provide media consent for my child.
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Payment
My Products
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Term 4 Goalkeeper
Price for 8-week program
$100.00 AUD
$
100.00
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00 AUD
$
0.00
AUD
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
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