(PO Box 1366 West Leederville WA 6901). Credit Card. Please charge to my credit card: Visa MasterCard. Card number: __ _
PERTH GLORY
MasterCard
ALL
Card number: __ __ __ __ / __ __ __ __ /__ __ __ __ /__ __ __ __ Expiry date: ___ /___
CVV number: __ __ __
THIS
Cardholder’s name:__________________________________
FOR
Signature: __________________________________________ TOTAL AMOUNT:_____________________________________ *Refunds available upon presentation of Doctors medical certificate
You agree not to bring any claim or proceeding against Perth Glory FC, their sponsors, their employees, and volunteers of the event for any damage, loss, injury or liability you or your Child may suffer from participating in the event, within reason. PHOTOS (PLEASE READ CAREFULLY)
Please tick the box if you DO NOT authorise the event staff to take pictures/videos of your Child. You acknowledge that the event organiser’s may use pictures/video of your Child in publicity and advertising material (children’s names are not used in conjunction with images) and that copyright and all associated rights in these pictures/videos is owned by Perth Glory FC. Please tick the box if you DO NOT want to be contacted by Perth Glory FC with further information on the club’s activities.
For Soccer Schools Terms & Conditions please see perthglory.com.au
PARENT/GUARDIAN SIGNATURE: I,_________________________ (print name) am the parent/ guardian of the named Child. I have read this document and understand its contents, including the exclusion of liability and assumptions of risk, and consent to my Child attending/participating in the Event. Signature:__________________________________________ Date: _____/_____/ 2016 *GLORY MEMBER DISCOUNT NOT APPLICABLE ON SPECIAL OFFERS
SHOP ONLINE OR IN STORE SHOP.PERTHGLORY.COM.AU
$35
20 OXFORD CL, W. LEEDERVILLE MON-FRI 9-5
Perth Glory Football Club’s Community Department aim to provide children of all abilities a dynamic, challenging and fun experience within a professional training environment. For details and general information about the Community Department please: visit www.perthglory.com.au/community or email
[email protected]
SEPTEMBER / OCTOBER CLINICS ON SALE NOW
Visa
YEA RS OF
KIDS PACK
Cheque Payable to Perth Glory Football Club (PO Box 1366 West Leederville WA 6901) Credit Card Please charge to my credit card:
BRAND NEW
1996 ST. GL O RY
EFT Payment BSB: 036-011 – Account: 422860 Reference: Include program code SS and child’s surname Date of payment:________________
JUST ARRIVED OUR AWESOME
E
OUR PAYMENT OPTIONS
RY RS * O L E G MB 20% E M VE SA
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OUR SOCCER SCHOOLS PLAY FOR FUN, ENJOY AND IMPROVE Train and play with Perth Glory at the Hyundai A-League’s best holiday clinics this Sep / Oct school holidays. Our Soccer Schools cater especially for the ages of 4 to 13 in a fun-filled, dynamic learning environment.
HURRY EARLY BIRD
120
$
LIMITED OFFER
PP
WHERE AND WHEN BALCATTA SC'S GRINDLEFORD RESERVE Tuesday 27th and Wednesday 28th September
CANNING'S WILLETON PARK
>>
REGISTER NOW
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PARENT GUARDIAN DETAILS Full Name:________________________________________________ Address:_________________________________________________ Suburb:__________________________ Postcode:_______________
Thursday 29th and Friday 30th September
Email Address:____________________________________________
MELVILLE CITY'S GAIRLOCH RESERVE
Home No:________________________________________________
Monday 3rd and Tuesday 4th October
Mobile No:_______________________________________________
SORRENTO FC'S MARRI PARK
How did you hear about the Soccer Schools?____________________
Monday 3rd and Tuesday 4th October
SUBIACO AFC'S LAKE JUALBUP Thursday 6th and Friday 7th October
________________________________________________________
CHILD 1 Full Name:________________________________________________ Date Of Birth:_____________________________________________ Gender:
PROGRAM DETAILS • • • • • • • • •
Professional Coaching Soccer Schools T-Shirt NEW PGFC Backsack NEW PGFC Wallet NEW PGFC Wristband Perth Glory Team Poster Child's GA ticket voucher Harvey Fresh Juices Certificate of Completion
PARTICIPATION REQUIREMENTS • • • • •
Appropriate football attire 2 x Waterbottles Sunscreen and a hat Packed lunch Positive attitude with a smile
Male
Female
Primary School:____________________________________________ Football Club:_____________________________________________ Medical Conditions (if any): Attach details
OUR COACHES CALLUM SALMON
Community and Development Manager
• PGFC U18 Head Coach • UEFA B License
MICHAEL GARCIA
Community and Development Officer
• FFA C License Coach • Former Perth Glory player
STEPHEN PURTON
Community and Development Officer
• FA Level 2 Coach • NPL State League Player
To register & discover our range of discount options visit perthglory.com.au/soccerschools, email
[email protected] or call 9492 6000
Emergency Contact:________________________________________ Soccer School Location:_____________________________________
CHILD 2 Full Name:________________________________________________ Date Of Birth:_____________________________________________ Gender:
Male
Female
Primary School:____________________________________________ Football Club:_____________________________________________ Medical Conditions (if any): Attach details Emergency Contact:________________________________________ Soccer School Location:_____________________________________
CHOOSE LOCATION Balcatta SC's Grindleford Reserve
Tue 27th and Wed 28th Sep
Canning's Willeton Park
Thu 29th and Fri 30th Sep
Melville City's Gairloch Reserve
Mon 3rd and Tue 4th Oct
Sorrento FC's Marri Park
Mon 3rd and Tue 4th Oct
Subiaco AFC's Lake Jualbup
Thu 6th and Fri 7th Oct
Payment options on reverse