CHILD INFORMATION

Child First Name

Child Last Name

Birth Date

Male/Female —Please choose an option—MaleFemaleOther

Playing Experience

Preferred Position —Please choose an option—DefensiveWingerMidfieldStrikerGoalkeeperDon't Have One

Days Available —Please choose an option—Saturday MorningsWednesday Nights from 5pmBoth of the above daysNeither days

NOTE: EPFA/AESC aims to run the academy in conjunction with training nights. Due to demand we may need to run on a different night/morning. Please indicate your availability

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name

Address

Contact Number

Email Address

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