Strikers Youth Academy - 2018
Date of Birth
Relationship to Player
Secondary Contact Number
Does your child have any medical conditions that the club/coach needs to be aware of?
Yes (please provide additional detail below)
If Answering 'Yes' to the above question, please provide details.
Registration for each block of 'Strikers Youth Academy' is $150 per block, or a one off payment of $500, which includes all four blocks. Full payment must be made prior to, or during the opening week of each block.
Bank Details: Account Name: Devonport City Soccer Club Bank: Commonwealth Bank BSB: 067 402 Account Number: 0013 1873
When paying via EFT, please put the payment reference as: child’s name & 'academy'. (i.e. ‘J Smith academy’). Please also email your payment advice to email@example.com
Enter the message as it's shown
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm