Kyah Simon - Contact: Get in Touch

Name

Last

Birthdate

Age

Address

Email

Emergency contact name

Emergency contact phone number

Nike Shirt Size

Nike jersey sizing chart

Have you previously attended a KS17 Football Clinic?

Yes

No

Is the participant registered with a local club?

Yes

No

Please provide the club’s name

Playing position

How did you hear about KSFC?

Does the participant have any medical conditions?

Yes

No

Allergies? Please list if applicable:

Does the participant wish to be grouped with family/friends?

Yes

No

Please enter the names of other participants here

Select Clinic Location

Registration Fee - $180 AUD

Payment Option

Consent to Participate

I give permission for the above-named participant to take part in the KS17FC Football Clinic. I understand that while all reasonable precautions will be taken, football and physical activities carry inherent risks, including the risk of injury.

Medical Treatment Consent

In the event of an accident or emergency, I authorise KS17FC staff or volunteers to seek medical attention or treatment for my child/me as deemed necessary. I understand that all efforts will be made to contact the emergency contact listed above.

Media Consent

Yes

No

I give permission for photos and videos taken during the clinic to be used by KS17FC for promotional and social media purposes. I understand that no names will be used without additional consent.

Waiver and Release of Liability

I acknowledge that participation in KS17FC clinics involves physical activity and the risk of injury. I release and hold harmless Kyah Simon, KS17FC staff, volunteers, and associated venues from any liability, claims, or demands related to personal injury, property damage, or loss sustained during participation.

Acknowledgement & Consent Confirmation

I have read and agree to the KS17FC Clinic Terms & Conditions, Consent & Waiver Form.

By ticking this box, I confirm that I have read and agree to the KS17FC Terms & Conditions and Consent & Waiver Form. I understand the risks involved in participation. I acknowledge that media consent is addressed separately and can be selected as Yes or No within the form.

My Cart

Registration Form

Registration Fee - $180 AUD

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@kyahsimon

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