Enrolment | Soccer School Palmerston North | Shane Rufer School of Football

Enrolment

Parents/guardians can complete the form below to register a player for After School or School Holiday soccer programmes in Palmerston North.

Player details

First Name*

Surname*

Gender*

M F

Date of Birth*

Club

School

Does the player have any medical conditions?*

Yes No

If yes, please provide details

Parent/Guardian details

Parent/Guardian Name(s)*

Postal address*

Phone*

Email*

Enrolment details

Select registration Package*

After School Programme (10 x 1–1½ hr sessions @ $150)

Holiday Programme (5 x 3hr sessions @ $150)

*For Casual attendance, to purchase additional sessions or register another family member, please call Shane on 021 622 101 or make an enquiry.

Payment details

Select payment method*

Internet banking Cash/Cheque

Bank Account Details:

Account Number: 010178-0061855-00

Comments

Waiver of Liability – I give permission for my child to attend the Shane Rufer School of Football, and for the coaching staff to act for me in an emergency. I hereby waive and release all coaches and staff from any liability for injuries sustained to my child during attendance at the coaching clinic. I accept full responsibility for any medical bills and associated expenses incurred in the event of accident or illness sustained during the course of the coaching clinic. Shane Rufer School of Football reserves the right to modify the programme as it deems necessary for the benefit of all participants. Shane Rufer School of Football reserves the right to cancel clinics due to insufficient numbers.

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