Football 4 All Gala Day - 2016 (Football NSW)

Football NSW will be hosting its eighth football4all Gala Day on Sunday 19th June, 2016 at Valentine Sports Park, 235-257 Meurants Ln, Glenwood, NSW, 2768.

The below nomination form is for individuals that wish to take part in the football4all Gala Day that ARE NOT part of a Football4All program.

Please complete by Wednesday June 1st 2016.

If you wish to enter a TEAM into the Football4All Gala day please register HERE

Please select your FOOTBALL4ALL program*

Other - please state club/group

Please nominate the category which best suits you.

We will try our best to fit individuals with others of similar age groups and ability based on the below questions.

The below categories are only to be used as a general guide and may not be strictly adhered to as the aim of this gala day is to provide a fun football experience for as many of our members as possible.

Please select ONE of the options

Category 1 (Age 6 - 10)Category 2 (Age 11 - 15)Category 3 (16 - 21)Category 4 (22+)

Please select ONE of the options

IntellectualSensoryPhysicalPowerchair

Please provide participant details below

Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Please provide emergency contact details of a guardian present on the day of the football4all Gala day 2016

Emergency Contact*

First NameLast Name

Emergency Email Contact*

Emergency Phone Number*

Area CodePhone Number

Football NSW and approved media outlets will be filming various games and presentations at this event.

Approved photoraphers from FNSW and local media may also be in attendance.

To ensure compliance with State Ward regulations please notify Football NSW of any Wards of the State participating in this event.

I agree to the above information

If you have any queries please contact Ed Ferguson - edwardf@footballnsw.com.au - (02) 8814 4443

football4all Gala Day - 2016