Term 3 Northland FC Skill Centre Registration Form

Question Title

* 1. Players Name

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* 2. Players DOB

Date / Time

Date

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* 3. Players Gender

Male

Female

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* 4. Players Current School

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* 5. Is your child a New Zealand Citizen?

Yes

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* 6. Which Skill Centre Session will your child attend in 2021?

9/10th Grade Tikipunga Skill Centre

11/12th Grade Tikipunga Skill Centre

9/10th Grade Kerikeri Skill Centre

11/12th Grade Kerikeri Skill Centre

9-11th Grade Ruakaka Skill Centre

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* 7. Which club team (e.g Tikipunga AFC) does your child intend to register with in 2021?

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* 8. Parent/ Guardian Contact 1

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 9. Parent/Guardian Contact 2

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 10. Emergency Contact

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 11. Does your child have any medical conditions or take any medication that Northland FC should be aware of?

Yes

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* 12. If yes, please provide details

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* 13. Does your child have any recent injuries that Northland FC should be aware of?

Yes

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* 14. If yes, please provide details, including treatment plan information

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* 15. Family Doctors Contact Information

Name

Phone Number

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* 16. Medical Consent-

I/We give permission for the administrators and/or staff Coaches to obtain necessary medical attention and treatment for the child outlined in this registration form for any injury and/or illness during training sessions, games or any activity related to Northland FC.

Yes

Question Title

* 17. Photo and Video Release-

Northland FC will use images and videos from training, games and other areas of the club's program for promotional purposes. I/We give consent for our child's image to be used regarding their experience with Northland FC.

Yes

Term 3 Northland FC Skill Centre Registration Form

Question Title

* 1. Players Name

Question Title

* 2. Players DOB

Question Title

* 3. Players Gender

Question Title

* 4. Players Current School

Question Title

* 5. Is your child a New Zealand Citizen?

Question Title

* 6. Which Skill Centre Session will your child attend in 2021?

Question Title

* 7. Which club team (e.g Tikipunga AFC) does your child intend to register with in 2021?

Question Title

* 8. Parent/ Guardian Contact 1

Question Title

* 9. Parent/Guardian Contact 2

Question Title

* 10. Emergency Contact

Question Title

* 11. Does your child have any medical conditions or take any medication that Northland FC should be aware of?

Question Title

* 12. If yes, please provide details

Question Title

* 13. Does your child have any recent injuries that Northland FC should be aware of?

Question Title

* 14. If yes, please provide details, including treatment plan information

Question Title

* 15. Family Doctors Contact Information

Question Title

* 16. Medical Consent- I/We give permission for the administrators and/or staff Coaches to obtain necessary medical attention and treatment for the child outlined in this registration form for any injury and/or illness during training sessions, games or any activity related to Northland FC.

Question Title

* 17. Photo and Video Release-Northland FC will use images and videos from training, games and other areas of the club's program for promotional purposes. I/We give consent for our child's image to be used regarding their experience with Northland FC.

* 16. Medical Consent-

I/We give permission for the administrators and/or staff Coaches to obtain necessary medical attention and treatment for the child outlined in this registration form for any injury and/or illness during training sessions, games or any activity related to Northland FC.

* 17. Photo and Video Release-

Northland FC will use images and videos from training, games and other areas of the club's program for promotional purposes. I/We give consent for our child's image to be used regarding their experience with Northland FC.