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 4*

Please select:

U10-U12 Mon Nights, 4.30pm-5.30pm, 9 Sessions, 14th Oct - 9th Dec

U08 & U09 Tue Nights, 4.30pm-5.30pm, 9 Sessions, 15th Oct - 10th Dec

U13-U15 Thu Nights, 4.30pm-5.30pm, 9 Sessions, 17th Oct - 12th Dec

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