SECTION 1 CHILD'S DETAILS
Age & date of birth:
Does your child have any medical considerations (e.g. asthma, epilepsy, anaphylaxis) or special circumstances (e.g. custody issues) that we should know about?
If you answered 'yes' to the above question please provide details that will help us to keep your child safe.
What school does your child attend?
SECTION 2 I.H.A.D SCHOLARSHIPS
Is this player an I HAVE A DREAM scholarship player?
Name of Navigator
Navigator mobile number
SECTION 3 DAYS & TIMES - Please select one or more of the following sessions - age brackets are a guideline only
8 - 9 year old sessions
10 - 12 year old sessions (Tuesday session is now full)
13-16 year old sessions (Tuesday session is now full)
What are the main reasons for registering your child with Northland Futsal Academy?
SECTION 4 PARENT/CAREGIVER DETAILS
Relationship to child, e.g. mother, father, caregiver
Secondary name & contact phone number in case of emergency
I give my permission for my child's photo to be used for promotional and/or coaching purposes on Northland Futsal Academy Limited's Facebook page and/or website.
How did you hear about us?
SECTION 5 PRICES & PAYMENT OPTIONS
One session per week - $125.00 (or $230.00 for two siblings). Two session per week - $230.00 (or $450.00 for two siblings).
Payment can be made by cash, bank transfer or automatic payments.
* Account details: Northland Futsal Academy Ltd - Acc # 38-9017-0827021-00 (Please use your child's surname initials as a reference)
I will make payment by
SECTION 6 T&Cs
* I accept that all foreseeable risks and hazards have been identified and either minimised or eliminated and that Northland Futsal Academy is not liable for any injuries sustained to my child while in attendance at a Northland Futsal Academy training. (Our Health & Safety Policy and Risk Management information is available for you to read at our training sessions). * I give my permission for my child to be attended to by a certified 1st aider and/or emergency services in case of an emergency. (Note: All NFA staff have a current 1st aid certificate).
Do you have any other comments or questions?