Name of Participant:
*
Name of Parent:
*
Age:
*
Gender:
Male
Female
Event Group :
*
Select an option:
4yrs-7yrs (August 10th) - $25
8yrs-12yrs (August 8-11th) - $85
13yrs-16yrs (August 10th) - $25
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.
*
indicates required fields