New Child Regd form – Dummy

Name of child*

Date of Birth*

School*

Allergies if any

Parent's Name*

Parent's Phone Number*

Address*

Parent's Email ID*

Emergency Contact's Name*
Please provide an emergency contact name different from the parent listed above

Emergency contact number*
Please provide an emergency contact number different from the parent listed above

Centre Name*

Programs*

No of playing days*

No of Uniforms*

Sign Off on Terms & Conditions*

Sign Off on Waiver*

We use photos/ videos from Great Goals programs in our promotion material. We would like your consent for your child's photos/ videos being used*

Yes, I consent No, I do not consent

You will receive an invoice within 48 hours. Please submit the payment along with a signed copy of the Invoice.

Football – Just for Girls (2005-2011)