Venom Football

Childs Name:

Childs Age:

Sex:

Male
Female

Address

Phone:

Email:

Allergies/Dietary requirements

Pleases add me to the email list

Yes
No

How did you hear about us?

Club
School
Friend
Facebook
Instagram
Twitter
Google
Other

Please read and tick to confirm the below

I/we authorise Venom Football to obtain, at my cost, medical, hospital and ambulance services in the case of an accident or emergency involving my child.
I/we agree to indemnify Venom Football and any person associated with the program in relation to any claim for damages as a result of an accident or injury to my child unless it is the direct result of negligence on the behalf of Venom Football or associated persons.
Venom Football protects the confidentiality and privacy of individuals by ensuring records about individual children and families, are kept in a secure place and are only accessed by or disclosed to those people who need the information to fulfill their responsibilities at the service or have a legal right to know.
I/we have read and agree to the conditions outlined in the Venom Football Enrolment.