Thank you for your interest in the 2018 Season Trials for West Torrens Birkalla. All players under the age of 18, must have their parent/guardian complete this form prior to trials.  If new to the club, proof of age must be brought to the trials and presented to the registration desk.  Proof of age can be passport/birth certificate/School ID card/drivers licence (learners or P's)/photo ID confirming date of birth

* 1. Player First Name

* 2. Player Surname

* 3. Home Address

* 4. Player Email Address (optional)

* 5. Player Mobile Number (optional)

* 6. Birth Date (dd/mm/yyyy)

* 9. Player's FFA Number

* 10. Which age group will the player be trialling /registering for?

* 11. Mother's Full Name

* 12. Mother's Email Address

* 13. Mother's Home Number

* 14. Mother's Work Number

* 15. Mother's Mobile number

* 16. Father's Full Name

* 17. Father's Email Address

* 18. Father's Home Number

* 19. Father's Work Number

* 20. Father's Mobile Number

* 21. If successful, will both parents be responsible for payment of fees?

* 22. Does the player suffer from any of the following medical conditions?

* 23. If you have indicated that the player suffers from a medical condition, please make any further comments that may be necessary, and may provide further information on management of the condition.

* 24. I/My child hereby agree(s) that West Torrens Birkalla Soccer Club ("The Club") including any of its officers and/or members shall not be held responsible for any accident, illness or injury sustained by me/my child while playing at, or attending any function with, The Club. I understand that The Club carries only basic player’s insurance (provided through registration with FFSA) and that it is my responsibility to arrange additional insurance cover. The Club recommends that every player takes out their own private health insurance including ambulance cover. Although players are covered by the FFSA Group Personal Accident Insurance whilst playing or training, the Club will not be liable for any cost not covered by the FFSA insurance that shall be for the account of the players. I also give my permission for The Club to arrange medical attention for me/my child that may be deemed necessary including ambulance transport and I agree to pay for all such costs incurred. The Club agrees that it will do its utmost to contact either parent, if possible, prior to seeking medical treatment for my child, but I understand and accept that it may not be possible to do so in all circumstances. The Club agrees to contact either or both parents as soon as it is practicable to do

* 25. Disclaimer: West Torrens Birkalla Soccer Club is not obligated to accept any or all children who trial to play at West Torrens Birkalla.  In addition, our Technical Director/s will determine the appropriate squad or team, which is the best age environment and/or applicable skill level, that is most conducive to the development of the child to play soccer.  Our decision to where children are to play is final and may be subject to change at the requirement of the club prior to or during the season.

* 26. Parent/Guardian "signature" - please state your name

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