Soccer Mums Come and Try Session RSVP Form
To help Mums experience the program without worrying about commitment and payment, Soccer Mums offers free come and try events so you can try before you buy into a program!
Please select your Soccer Mums Location:
Ballarat Morshead Park - Saturday 1 Feb 9-10am
Brunswick City - Friday 14 Feb 5:30-6:30pm
Casey Stadium - Wednesday 5 Feb 9:30-10:30am
Chelsea FC - Wednesday 19 Feb 7-8pm
Darebin Falcons - Wednesday 19 Feb 7-8pm
Glen Eira - Tuesday 4 Feb 6-7pm
Knox Regional Football Centre - Monday 10 Feb 7-8pm
Maribyrnong Swifts - Wednesday 12 Feb 6:30-7:30pm
Maribrynong Swifts - Saturday 15 Feb 10-11am
Middle Park - Wednesday 12 Feb 6-7pm
Mount Martha - Friday 7 Feb 9:30-10:30am
Mount Martha - Saturday 8 Feb 9:30-10:30am
Mount Waverley SC - Saturday 1 Feb 9-10am
Portland SC - Saturday 8 Feb 11-12pm
Portland SC - Tuesday 11 Feb 5-6pm
Sunbury United - Sunday 2 Feb 10-11am
Surfside Waves (Ocean Grove) - Wednesday 5 Feb 9:30-10:30am
Year of Birth
Are you the parent or carer of any children in your household? This includes children over 18 years.
If so, what age group(s)?
18 and over
In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job.
Does the answer to the above question about your activity include the Soccer Mums Free Come and Try Session?
How confident are you about being able to participate in physical activity on a regular basis?
(Not Confident at all)
0 is (Not Confident at all), 10 is (Extremely Confident)
Do you have any pre-existing medical or health conditions that may impact upon your ability to participate in Soccer Mums?
If so, please list these pre-existing medical or health conditions:
Emergency Contact Details: (Name, Mobile Number and Relationship to participant)
Are you associated with a Soccer Club?
If so, in what capacity?
My child or children play soccer
Where did you hear about the Soccer Mums Free Session Offer?
VicHealth Soccer Mums Social Media /Website
A friend or family member
Your Clubs Facebook page
Melbourne City FC Website/Social Media
VicHealth - This Girl Can Vic
If you have selected other, please specify below:
La Trobe University is evaluating the Active Women and Girls for Health and Well being and the Regional Sport Program, both support by VicHealth. La Trobe would like to talk to some participants more in-depth over the telephone about their experiences with the Soccer Mums Program. Participants will be randomly selected for an interview and reimbursed (a $50 Coles Myer Gift Card) for their time. Would you be willing to share your experiences?
Please read through and agree to the below terms and conditions before clicking Submit
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