Join our Specialist Football Program!

Student Name* This field is required.

First Name

Last Name

What is your child's gender?* This field is required.

Date of Birth* This field is required.

Date

Parent Name* This field is required.

First Name

Last Name

Email* This field is required.

example@example.com

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Mobile Number* This field is required.

Home Phone Number

Area Code

Phone Number

Current School* This field is required.

Do you have any siblings attending, or who have attended Safety Bay Senior High School?* This field is required.

YESNO

Does your child have any important medical conditions we need to know about?* This field is required.Particularly conditions that could affect them during the trials. Please list them below.

Please provide a copy of the most recent School Report* This field is required.If you are unable to upload a recent school report please call Administration on 9527 0200.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Do you give permission for your child to be photographed or recorded during the trial? * This field is required.Photographs and videos may be used for promotional purposes.

YESNO

Current Football Club

Competition Level

Preferred position/s:

Tell us about your experience with Football: e.g tell us how long you have being playing for and what you hope to get out of Football

How did you hear about our Specialist Football Program?* This field is required.Select all that apply

Facebook

School Sign

Connect

Local Newspaper

School notice/newsletter

Poster

Do you have any feedback to help us improve our registration process for next time?

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