SCHOOL HOLIDAY PROGRAM REGISTRATION

Monday 15th - Friday 19th April

SECTION 1: CHILD'S DETAILS

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?



Please select the days your child will be attending.






SECTION 2: PARENT/CAREGIVER DETAILS

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.



SECTION 3: PAYMENT AND FEES

SHP FEES - $55.00 per day or $50 per day for 3 or more days. 10% discount for siblings.

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: SHPT1

SECTION 4: TERMS AND CONDITIONS

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


How did you hear about our holiday program?