2024 Senior Womens Acceptance - Campbelltown City Soccer Club

"*" indicates required fields

Player Name*

First Surname

Player Gender*

Female

Other

Player DOB*

Age Group for 2024 Season*

Does you have asthma?*

Yes

Do you have allergies?*

Yes (Please specify)

Known allergies

Please detail any other medical information we should be aware of

Contact #*

Email*

Parent/Guardian Name

First Last

Parent Contact #

Parent Email

Address*

Street Address City State Postcode

Name*

First Surname

Contact #*

Relationship to Player*

Total Payment

Credit Card*

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name