FOOTBALL TECHNIQUE AUSTRALIA
FOOTBALL REGISTRATION FORM
CLUB YOU ARE PLAYING FOR
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Player Name
First Name
Last Name
Date of Birth
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/
Day
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Month
Year
Date Picker Icon
E-mail
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Phone Number
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Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
Postcode
Any Medical Conditions?
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Yes
No
If answered yes please identify medical condition
Emergency Contact Person
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First Name
Last Name
Emergency Contact Number
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Area Code
Phone Number
PROGRAM OPTION & COST
Please note Term Fee does not include the FTA uniform. There is a once off fee. Please tick if you require an FTA uniform.
CHOOSE YOUR PROGRAM LOCATION
Keilor Downs - 100 Odessa Avenue, Keilor Downs VIC 3038
CHOOSE YOUR TRAINING PROGRAM
FOOTBALL
GK PROGRAM
FTA ELITE PROGRAM
CHOOSE YOUR TERM
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TERM 1 - 20th January 2018 - 31st March 2018 (Saturday 9:00am - 10:15am)
TERM 2 - 21st April 2018 - 23rd June 2018 (Saturday 9:00am - 10:15am)
TERM 3 - 14th July 2018 - 15th September 2018 (Saturday 9:00am - 10:15am)
Term 4 - 13th October 2018 - 15th December 2018 - Saturday 9:00am
PROGRAM COST
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TERM 1, 2 & 3 = $195 Per Term (Sat morning - 1 session per week)
TERM 4 = $240 (Saturday - 1 session per week)
GK Program Term 1, 2 & 3 = $280 Per Term (1 session per week - Saturday)
DO YOU REQUIRE THE FTA UNIFORM - Top, shorts, socks, jacket
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Yes = Additional $120
No
TERMS & CONDITIONS
Training must be paid in full before training commences. If participant cannot attend pre-paid training for whatever reason, money can NOT be reimbursed. The only time that a session will be cancelled is when there is lightning, due to ground unavailability or specific Football Technique Australia requirements.
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I agree with the above terms and conditions
SPORTS RISK WAIVER
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I acknowledge that there are inherent risks involved in my child participating in the Football Technique Australia. I discharge Football Technique Australia (including all directors, employees, coaches and guest coaches/ players) from any and all liability for injury, loss or damage caused arising out of my participation in the Football Technique Australia. I agree that I will not sue Football Technique Australia (including all directors, employees, coaches & guest coaches/ players) in the future, for any kind of injury, damage or loss that occurs while participating in Football Technique Australia. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.
PHOTOGRAPHIC/VIDEO CONSENT & RELEASE FORM
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I do hereby consent and agree that Football Technique Australia has the right to take or use photographs or video recording of me and to use these in any and all media including online, now or hereafter known, and for any purpose whatsoever. I further consent that my name and identity may be revealed there in or by descriptive text or commentary. I do hereby release to Football Technique Australia all rights to exhibit this in print and electronic form publicly or privately and to market and sell copies. Any rights, claims or interest I may have to control the use of my identity or likeness in the photographs and agree that any uses described herein may be made without compensation or additional consideration of me. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.
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