Name of Participant: *

Name of Parent: *

Age: *

Gender:

Male
Female

Event Group : *

Any Medical Illness? *

No
Yes

If yes, please state the illness:

Email:

Telephone Number: *

Payment:

Bank Transfer
Cash (Pay at the Door)

Comment:

By submitting this form, you agree to indemnify and to hold harmless Footy Promotions, its members, coaches, officers or designates from any kind of claim whatsoever.

By submitting this form, I give permission for Footy Promotions and affliates to use any pictures, videos and media taken of my child during this event for promotion purposes.

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