Begins week of Monday 25th October - Ends week of Monday 13th December
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
8 - 9 year old sessions
10 - 12 year old sessions
13-16 year old sessions (Friday session is now full)
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 4 fees - $125.00 or $230 for 2 sessions per week.
Payment can be made by cash or bank transfer.
* Account details: Northland Futsal Academy Ltd - Acc # 38-9017-0827021-00 Reference: 1st Initial/surname. Code: Term 4
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. (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?