Auckland United F.C.

Players Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parents Name *

First Name

Last Name

Phone Number *

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Waver to Participate *

I give my child permission to attend the Auckland United F.C Academy programme and waive all liability for accident and injury.

Yes

Payment Options *

U8 $650 (3 Term Programme) U9-U14 $950 (3 Term Programme)

Monthly (March- July)

Annual payment (Discounted Proce)

Does not apply