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Fantastic School Holiday Fun I, ______(Print Name) Am the Parent/ Guardian of the Named Child PAYMENT EFT Payment BSB: 036-011 – Account: 422860 Reference: Include program code SS and child’s surname Date of payment:________________ Cheque Payable to Perth Glory Football Club (PO Box 1366 West Leederville WA 6901) Credit Card Please charge to my credit card: Visa MasterCard “ Michael and Hana loved learning new skills, meeting new friends and playing Card number: __ __ __ __ / __ __ __ __ /__ __ __ __ /__ __ __ __ the games. They enjoyed learning about Expiry date: ___ /___ diet and nutrition and they thought the 2011 6- coaches and Glory players were fantastic. 9 Y 9 1 R Cardholder’s name: ________________________________ O L G F I’ll definitely be sending them again and O S R FI A FTEEN YE Signature: ______________________________________ I have no hesitation in recommending the Soccer Schools!” TOTAL AMOUNT: ________________________________ Nancy Lowry *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 “ W h a t a g r e a t w a y t o s p e n d y o u r H o lid a y s , event for any damage, loss, injury or liability you or your Child not only are they having fun they are may suffer from participating in the event, within reason. learning at the same time. A fantastic PHOTOS (PLEASE READ CAREFULLY) experience for the children to have the Please tick the box if you DO NOT authorise the event staff to opportunity to mix and learn from the take pictures/videos of your Child. You acknowledge that the professionals at Perth Glory” event organiser’s may use pictures/video of your Child in publicity and advertising material (children’s names are not Toby Levy, Junior Development Coach, used in conjunction with images) and that copyright and Sorrento FC 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 enquiries please contact For Soccer Schools Terms & Conditions please see perthglory.com.au Perth Glory Football Club on 9492 6000 or email PARENT/GUARDIAN SIGNATURE: [email protected] Fantastic School Holiday Fun 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. 011 011 6-2 6-2 99 99 1 1 Y Y R R O O L L Signature: _____________________________________ G G F F F O F O IF RS IF RS TEEN YEA TEEN YEA Date: _____/_____/ 2012 Major Community Partner Major Community Partner To follow up the amazing success of the Soccer Schools inaugural year, Perth Glory FC are very excited to announce the next clinics MEET THE COACHES REGISTER NOW at Melville City’s Gairloch Reserve and Subiaco AFC’s Rosalie Park. PARENT GUARDIAN DETAILS Your child will participate in the very best learning environment CALLUM SALMON Community and Development Mana ger whilst having as much fun as possible! Our Soccer Schools are Last Name: ________________________________ inclusive of social, recreational and elite footballers – the aim is • Former Sunderland AFC First Name: ________________________________ for everyone to Academy Coach Address: __________________________________ • Work hard and get a sweaty shirt • Former Sunderland AFC • Improve and gain a new skill set Foundation Coach Suburb: _________________ Postcode: _________ • Smile and enjoy football • Former Football West Email Address: _____________________________ The Soccer Schools cater especially for the ages of 5 – 12. The two NTC Youth Coach Home No: _________________________________ day course (9am – 3pm) is an initiative that promotes all aspects • UEFA B Licence of a Football education. Participation, inclusion and improvement Mobile No: _________________________________ are key elements to our program whilst providing an enjoyable and How did you hear about the Soccer Schools? _______ stimulating learning atmosphere. MICHAEL GARCIA Community and Development Officer _________________________________________ PROGRAM DETAILS ONLY • Former Perth Glory FC player PRICE FREEZE PRICE FREEZE CHILD 1 For a total investment of $150 (2 days) • Former Canberra Cosmos player $75 • Australian Youth International Last Name: ________________________________ each participant will receive: PER DAY • Asian C Licence • Two day professional coaching First Name: ________________________________ • Season 2012/2013 Date Of Birth: ______________________________ Perth Glory Game GA Ticket • PGFC Soccer Schools shirt* BOBBY DESPOTOVSKI Gender: Male Female Community and Development Coach • PGFC Waterbottle* Primary School: ____________________________ • PGFC Backsack* • PGFC Skill football* • Perth Glory FC Legend Football Club: ______________________________ • Sponsors giveaways • 241 Games played • 131 Goals scored Medical Conditions (if any): Attach details *New giveaways • Asian B Licence Emergency Contact: _________________________ In addition, Perth Glory FC players • Johnny Warren Medal 2005/06 will be available for autographs, Soccer School Location: _______________________ Q&A’s, award presentations and • Hyundai A League Golden Boot best of all play with the juniors! 2005/2006 CHILD 2 Participation Requirements • Appropriate football attire Last Name: ________________________________ COACHES TOP TEN TIPS • Waterbottles 1 ) P r a c ti c e p a s s in g a f o o tb a l w it h y o u r l e ft & r ig h t f o o t First Name: ________________________________ • Sunscreen 2) Encourage your team mates • Packed lunch Date Of Birth: ______________________________ • Positive attitude 3) Listen to your coach 4 ) R e m e m b e r t o d e fe n d Gender: Male Female 5 ) J o in i n t h e a t a c k Primary School: ____________________________ VENUES & TIMES 6) Always display a good attitude Football Club: ______________________________ MELVILLE CITY’S GAIRLOCH RESERVE 7 ) P r a c ti c e d r ib b lin g w it h b o th f e e t a n d a l p a r ts o f t h e f o o t 9am – 3pm Monday 16th and Tuesday 17th of April (inside, outside, soles, laces) Medical Conditions (if any): Attach details 8 ) W a tc h t h e b e s t t e a m s i n t h e w o r ld p la y Emergency Contact: _________________________ SUBIACO AFC’S ROSALIE PARK 9) Play with your mates 9am – 3pm Monday 23rd and Tuesday 24th of April 10) Enjoy the game! Soccer School Location: _______________________.
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