JUNIOR AND YOUTH DEVELOPMENT PROGRAMS BOOKING

Name *

First

Last

Date of Birth *

Gender

Email *

Medical Conditions *

By completing this registration form you are authorizing Waikato Football Academy to act on your behalf should you/your child require medical attention, and release Waikato Football Academy from any liability for injury incurred by you/your child during the course.

Parent's Name *

First

Last

Parents Contact Number *

Program Selection

Non Claudelands Rovers FC Players please advise which school/club you will play for this year.

Photographs may be taken of the players and staff to be used as promotional material only. Please indicate below if you consent or not for your child to be included.

Yes I do consent to photos/videos being taken of my child during the program
No I do not consent to photos/videos being taken of my child during the program

Phone