Join our Specialist Football Program!

Student Name

First Name

Last Name

Student First Name* This field is required.

Student Surname* This field is required.

Date of Birth* This field is required.

Date

Student Gender* This field is required.

Parent Title* This field is required.

Mrs

Miss

Parent Name* This field is required.

First Name

Last Name

Parent Email Address* This field is required.

example@example.com

Home Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Mobile Number* This field is required.

Current Student Primary School* This field is required.

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

Does the student have any siblings attending, or who have attended Safety Bay Senior High School? If yes, please provide their name* This field is required.

Please provide a copy of the student's most recent School Report* This field is required.If you are unable to upload a recent school report please call Administration on 9528 9200.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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

YESNO

Current Football Club

Competition Level

How long has the student been playing/interested in football?

Preferred position/s:

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

Safety Bay SHS Football Facebook

Safety Bay SHS Instagram

Safety Bay SHS Facebook

Safety Bay SHS Website

Safety Bay SHS Sign

Connect

Local Newspaper

Primary school notice/newsletter

Trial Poster/Flyer

Other

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Join our Specialist Football Program!