Name *

First Name

Last Name

Phone Number *

Country

(###)

###

####

Date of Birth *

MM

DD

YYYY

Age *

16

17

18

19

20

21

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Number *

(###)

###

####

Playing Position *

Tick Multiple

Goal Keeper

Centre Back

Right Back

Left Back

Defensive Midfield

Centre Midfield

Attacking Midfield

Right Wing

Left Wing

Striker

Please Read Carefully *

We are committed through trained and competent staff to providing a safe learning environment, however, football is a contact sport and injuries may occur through no negligence of our staff. We feel it is our responsibility to ensure the safety of the attendee by making sure they come well equipped for the activity i.e. correct footwear, appropriate clothing, food/drinks if appropriate, medication (if applicable). I have read and understood this statement, completed all the details requested to the best of my knowledge and will comply with the information set out. I acknowledge and accept that MH Football World or respective servants shall not have any liability in respect with any loss or damage to property and give permission for my child to receive emergency medical treatment in my absence if deemed necessary.

YES, I AGREE

NO, I DO NOT AGREE