Academy Program Enrolment - Campbelltown City Soccer Club

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Player Details

First Name*

Surname*

Date of Birth*

Current Club

Program Details

Academy Programs 2024 Term 3*

Please select:

U11 & U12 Mon Nights, 5.00pm-6.00pm, 9 Sessions, 29th Jul - 23rd Sep

U08 & U09 Tue Nights, 5.00pm-6.00pm, 9 Sessions, 30th Jul - 24th Sep

U10 & U11 Thu Nights, 5.00pm-6.00pm, 9 Sessions, 1st Aug - 26th Sep

Parent/Guardian Details

First Name*

Surname*

Contact Number*

Email*

Further Player Details

Confidential Medical Information*

Medical Assistance*

In the unlikely event of an emergency I authorise the staff of Campbelltown City Soccer Club to seek and/or perform appropriate medical attention.

Media Release*

I give permission for the player's name which appears on this registration form to be photographed and/or filmed while enrolled in soccer programs with Campbelltown City Soccer Club. I understand that when such photos or videos are posted on the website or used for marketing purposes they will be used in accordance with the Privacy Act (1988).

Terms & Coniditons*

I agree to the Academy terms & conditions.

Click to view Academy Terms & Conditions.

Total

Credit Card*

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name