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

Auckland United F.C Player *

All Auckland United F.C Players must commit to the full time programme and annual fee.

Yes, I Accept.

Direct Debit *

U9-U10 $600 (3 Term Programme) U11-U13 $900 (3 Term Programme) U14-U16 $1300 (3 Term Programme)

Fortnightly (Feb-Sept)

Monthly (Feb- Sept)

Annual payment (5% discount - due Feb)

Does not apply