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Tuesday 1st October 2024 | 9am-11am

Tuesday 1st October 2024 | 9am-11am

Parent / Guardian Details

First Name

Last Name

Email

Mobile

Street Address

City/Suburb

State

Zip/Postcode

Participant Details

First Name

Last Name

Address same as Parent / Guardian

Street Address

City/Suburb

State

Zip/Postcode

Emergency Contact (if different from above)

Please provide name and mobile number.

Gender

Medical Information

Please provide any relevant medical details. If this is not applicable please enter N/A.

Age

Favourite Team and Player

Additional Information

Photography Consent

I acknowledge and consent to photographs and electronic images being taken of registrant during their participation in the program. I, as the parent/guardian of registrant acknowledge and agree that such photographs and electronic images are owned by Adelaide Football Club and that the club may use the photographs for promotional or other purposes without my further consent being necessary.

Payment Summary

Event	Price	Quantity
Tuesday 1st October 2024 \| 9am-11am	$89.00	1
Promotion Code
TOTAL TO PAY: $89.00 (AUD) Inc. tax $8.09

Credit Card Details

Accepted Credit Card

Accepted Credit Card: AMEX

Accepted Credit Card: MasterCard

Accepted Credit Card: Visa

Card Type*

AMEX

MasterCard

Visa

Name On Card

Card Number

Expiry Date

Security Code

By clicking on the submit button, I agree to the terms and conditions

Tuesday 1st October 2024 | 9am-11am