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 DAYS & TIMES - Please select one or more of the following sessions - age brackets are a guideline only
Junior SessionsOur Junior sessions for Term 1 are now full.
Intermediate Sessions (10 - 12yrs)
Youth Sessions (13+yrs)
What are the main reasons for registering your child with Northland Futsal Academy?
SECTION 3 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 4 PRICES & PAYMENT OPTIONS
Term 1 fees - $169.00 or $155 per player for 2 or more siblings.
Payment can be made by bank transfer (one off or 4 x installments).
* Account details: Northland Futsal Academy Ltd - Acc # 38-9017-0827021-00 Reference: 1st Initial/surname. Code: T1 24
I will make payment by
SECTION 5 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.. * 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.
Do you have any other comments or questions?
n.f.a uniforms are recommended for all players. To order a uniform, please complete this google form (copy and paste the link)