CHILD'S DETAILS
First name:
Surname:
Age & date of birth:
Gender:
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?
Please select the days your child will be attending
Early drop offs available. Additional charges apply. Please comment in comment box below if necessary.
PARENT/CAREGIVER DETAILS
First name
Surname
Relationship to child, e.g. mother, father, caregiver
Mobile contact
Email:
Secondary name & contact phone number in case of emergency
MEDIA RELEASE
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 our holiday program?
Comments
TERMS & CONDITIONS *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. * I may be contacted and may need to pick my child up if their actions put themselves or others at risk of emotional or physical harm. By continuing, you agree to our Privacy Policy and Terms of Service
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