Registration Form

A copy of this form should be retained by the centre coordinator
Today's date: 19/9/2014
NAB AFL Auskick centre

Participant Information

Your NAB AFL Auskick Number
Date of Birth:
Status
 
Unpaid
Given Name
Male X
Female O
Surname
Street & Number
Suburb
Postcode:
State / Territory
Email
School attended
School Grade:
School suburb
AFL club supported
Member of this AFL club
No
AFL attended per season ?
AFL Games watched on TV?


Parent / Guardian Contact and Consent

Given Name
Surname
Email
Telephone

Will your child still play Australian Football (AFL) in any other competition other than in 2013? (with a minimum duration of 6 weeks)
Can you assist with any of the following?
Is your family happy to receive information and promotions related to the NAB AFL Auskick program from the AFL, AFL corporate partners, the AFL Club you support or your local junior club/s?
No
Does your child suffer from an illness or disability?
Does your child suffer from an allergy or is he/she allergic to any medication?
No
In an emergency, do you authorise the center coordinator to arrange any necessary medical treatment for your child where prior notification has not been possible?
No
I hereby confirm that the information provided by me herein is true and correct.

By signing this form I agree to the AFL Auskick Terms of Participation.
Signed
 
  Parent / Guardian
 

Receipt of Payment

 NAB AFL Auskick centre
Given name
OOOOOOOOOOOOOOOOOOOOOOOOO
Surname
OOOOOOOOOOOOOOOOOOOOOOOOO
Amount received $
OO (incl. GST)  Cash O  Cheque O

Signed
 
 ( centre coordinator)
The AFL takes care to ensure the confidentiality of the information provided to it on this application form and handles the information in accordance with the 10 national privacy principles set out in the Pricacy Act.