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.
Please select the days your child will be attending.
SECTION 2: 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.
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
How did you hear about our holiday program?
Please add any further information you feel may be important for us to know and/or any questions you may have.