2024 National Futsal Championships EOI
Please complete the information below, uniform order (sizing and extra gear) and the medical information. By completing this form you acknowledge your intent for you or your child to participate in the National Championships, understand the costs (to be finalised, but juniors c$3500 and seniors $3000) and commitment involved and give media consent for your child.
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Full player name (as per photo ID) *
Date of Birth *
MM
/
DD
/
YYYY
Best contact number *
Parents name/Emergency contact name *
Contact email address *
Photo and video consent *
Emergency contact number and email *
Dress shirt (Sizes are adult sizes)
Clear selection
Dress shorts
Clear selection
Playing/keeper jersey
Clear selection
Playing shorts
Clear selection
Playing socks
Clear selection
Please give 3 preferred playing numbers (jersey number)
Optional Extras (As part of the player levy, players receive all playing and dress gear that is required. This is in addition to included gear)
Optional extras info (item and size - ie Hoodie (Medium)
Medical information - does the player suffer from any of the following (select if yes): *
Required
Does the player have any special dietary requirements? If answering yes, please include details *
Has the player been vaccinated against: *
Required
Is the player allergic to any of the following? *
Required
If allergic to anything please give details
Please give details of any medications currently being taken
Medicare number
Private Health fund details (if any)
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