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OLE ACADEMY OF FOOTBALL
MINI-KICKERS TERM 1, 2012

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Register for a Program

SELECT A PROGRAM

Select an Ole Program*:

Holiday Camp Program Booking:
If registering for a Holiday Camp, please select days you would like your child to attend

PLAYER'S DETAILS

First Name*:
As shown on passport

Last Name*:
As shown on passport

Preferred Name*:

Gender*:

MALEFEMALE

Date of Birth*:

Current School*:

Height*:
in centimeters as a round figure

Weight*:
in kilograms as a round figure

Current Team:

Current Position:

Address*:

Postcode*:

Emergency Contact Number*:

Preferred Email*:

Preferred Contact Number*:

Preferred Mobile Number:
For SMS alerts

Mother's Email:

Mother's Mobile:

Father's Email:

Father's Mobile:

MEDICAL INFORMATION

Does your child suffer from any of the following:

Allergies (including food)AsthmaCurrent illness Current medicine Diabetes Disability Epilepsy Heart problems Other (please specify below)

Please provide any necessary information:

My child's level of swimming is:

WeakAverageStrong

Doctor's Phone Number:

Doctor's Name:

Medicare Number:

In the case of emergency I authorise the Staff of Ole Football Academy to seek emergency medical attention for my child.

Yes No

PAYMENT OPTIONS

Preferred Payment Method:
We will contact you to finalise your payment.

OTHER DETAILS:

Where did you hear about us?*

Other:
If you selected Other above, please specify.

I have read the Risk Waiver*:
Read the Risk Waiver here

Yes

I have read the Refund Policy*:
Read our Refund Policy here

Yes

Photo Permission*:
I give permission for my child to be photographed and/or filmed while enrolled in soccer programs with Ole Academy of Football. I understand that when such photos or videos are posted on the website or used for marketing purposes they will be used in accordance with the Privacy Act (1988).

Yes No

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