Name of Participant:
*
Date of Birth:
*
Age:
*
Gender:
Male
Female
Please select session(s) that you would like to attend:
Goalkeeper (July 1st)
Defender (July 3rd)
Midfielder (July 4th)
Striker (July 5th)
Are you interested in participating in a showcase match (July 6th - 10am)? $10
*
No
Yes
Any Medical Illness?
*
No
Yes
If yes, please state the illness:
Email:
*
Parent or Guardian:
*
Telephone Number:
*
Payment:
Bank Transfer
Cash
Comment:
By submitting this form, you hereby agree that Footy Promotions / Footy STAR Management, its members, coaches or officers, shall not be liable for any 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 STAR Management.
We agree to indemnify and to hold harmless Footy Promotions / Footy STAR Management, its members, coaches, officers or designates from any kind of claim whatsoever.
Please note that there are no refunds once the participant has started the camp.
*
indicates required fields