Welcome to Syked For Sport's 
Junior Football Academies
Child's Full Name: *

Gender: *

Date of Birth: *

I am registering my child for: *

Age Group: *

Football/ Auskick Club: *

Parent/Guardian Name: *

Mobile Number: *

Best Contact number (On the day): *

Home Address:

Any medical requirements: *

Please provide details:

Is there any other information you would like to inform us of? *

Please provide further information:

Parent/Guardian Consent and Authorisation for Children *

In the case of an emergency, I am aware that the Syked for Sport® team leader and/ or coaches will:
• Advise the emergency contact listed above.
• Seek medical attention or assistance for my child, at the nearest or most convenient medical/emergency facility.
• Arrange transport for my child if required (this may require transport by ambulance).

Whilst Syked for Sport® and its team leader and coaches will take all reasonable care to secure the safety of my child, I understand that neither Syked for Sport®, Syked for Sport®  team leader/ coaches, nor designated helpers, will be held responsible for any injuries incurred by my child, as a result of clinic activities.
Syked for Sport® and Syked for Sport® team leader/ coaches and helpers will not be held responsible for any costs incurred in securing medical treatment for my child; including medical assistance, treatment, ambulance, etc.

I hereby give my consent for the above named child to attend the Syked for Sport® Football clinic, that all Syked for Sport® staff and volunteers cannot be held liable for any accident or injuries that may occur during the duration of the clinic.

I consent to Syked for Sport® collecting, using and disclosing the personal, sensitive and health information on this form for the purpose of my child/ren’s participation in the Syked for Sport® Clinic, and in accordance with Syked for Sport®’ Privacy Policy. I agree to Syked for Sport® using any photos or videos taken of my child at the Syked for Sport® clinic for promotional purposes.

I, the undersigned, have read the consent and authorisation and understand all its terms. I execute it voluntarily and with full knowledge of its significance.
If you 'do not accept' to any of the above please state why?

Payment Details:

Please submit payment via bank transfer.
Bank details will be emailed to the address supplied after the form is submitted.

Please ensure payment is made 3 days prior to program.

$69.99 per child per clinic.
(See email for family and multiple day discounts).

***Please note payment cannot be made through this application, please make payment via your own internet banking.

Thank you for completing the registration form.

An email has been sent to you with finer details, including venue locations and payment procedure.
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