Date of Birth:
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Does the participant have any medical illness such as asthma?
If 'Yes' please describe medical condition
Has the participant been exposed to Covid-19 (if yes, please explain):
Would the participant have traveled in the last 14 days prior to October 16th, 2021?
Please note that it is your responsibility to let us know if your status on the Covid-19 questions have changed prior to the event.
Parent or Guardian:
Home Mailing Address:
Registration Fee: 190.00
Would you like to purchase Footy Tots tracksuit?
Participation includes possible exposure to and illness from infectious diseases including but not limited to influenza and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness does exist.
I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the terms for participation in regards protection against infectious diseases. If, however, I observe and any significant hazard during my presence or participation, bring such to the attention of an official.
By submitting this form, you hereby agree that Footy Promotions / Footy Force Futsal, its members, coaches or officers, shall not be liable for any and all illness, disability or injury
or loss which my child or children may sustain while participating in activities of any kind, whether sponsored by or under the supervision of the Footy Promotions / Footy Force Futsal.
We agree to indemnify and to hold harmless Footy Promotions / Footy Force Futsal, its members, coaches, officers or designates from any kind of claim whatsoever.
The Participant, and the Parent(s) or Guardian(s), if the Participant is a minor child, grant authorization to Footy Promotions / Footy Force Futsal
to use photographs of the Participant for publicity purposes including Website, social media and print advertising content.
Parent or Guardians Please Inital Here To Sign:
Please note that there are no refunds once the participant has started the Footy Tots Program sessions
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