Registration – Elite Pathways


REGISTRATION FORM

Kick off date - Monday, 24th February 2020

Total $475

Childs Name *

Date of Birth*

Parent Name*

Address*

Phone Number*

Mobile*

Email*

Emergency Contact (Name/Phone)*

Medical Condition (if any)

Siblings/Friends Attending Session

(Name & Age)

How did you find about Elite Pathways program?*

Current football club and Years of experience*

Next Gen Uniform Size*

OPTIONAL: Photo Consent for Next Gen Elite Pathways

I hereby give permission to Next Gen Elite Pathways to take photographs and/or videotape of my child/children and consent that these may be used for promotional purposes of the Next Gen Elite Pathways program in a manner that is not deemed adverse or defamatory to the person signing this form. Photographs /videotapes may also be used in the Next Gen Elite Pathways website, Facebook page, Instagram, YouTube accounts.

I HEREBY AGREE TO THE ABOVE MENTIONED TERMS AND GIVE PERMISSION TO NEXT GEN AS STATED:

Photo Consent

Fees:

$475 for 6 weeks.

PAYMENT WILL BE TAKEN VIA PAYPAL ON NEXT PAGE.


CHOOSE PAYMENT MODE


( Pay amount in 4 weeks )


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