Holiday Program Old - South Perth United Football Club

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Holiday Program

South Perth United Football Club is proud to announce that our soccer holiday program is making a comeback for the September school holidays, for children turning 8 to 14 in 2022! Download and View Flyer

Child's Name*
First Last
Child's Birthday*
Date Format: DD slash MM slash YYYY
Parent / Carer Name (First & Last)*
Parent / Carer Email Address*
Parent / Carer Relationship to Child*
Parent / Carer / Authorised Pick-Up No. 1 (Name, Phone)*
Parent / Carer / Authorised Pick-Up No. 2 (Name, Phone)*
Health Information & Permissions

Information Form – Confidential
(1) Does your child currently have any serious illness?*
- Yes (please provide details below at Q9)
- No
(2) Does your child require any medical procedures to be performed on a regular basis?*
- Yes (please provide details below at Q9)
- No
(3) Is your child receiving regular medication?*
- Yes (please provide details below at Q9)
- No
(4) Does your child have any allergies? Including food allergies or intolerances, reactions to insect bites, allergies to sunscreens, antiseptics, etc.*
- Yes (please provide details below at Q9)
- No
(5) If the answer to Q4 above is yes, is your child’s allergic reaction likely to result in anaphylaxis?*
- Yes (please bring a copy of your child’s Anaphylaxis Action Plan and Epipen to the workshop)
- No
(6) Does your child have Asthma?*
- Yes (please bring a copy of your child’s Asthma Management Plan and Reliever to the workshop)
- No
(7) Does your child have Epilepsy?*
- Yes (please bring a copy of your child’s Epilepsy Management Plan to the workshop)
- No
(8) Does your child have Diabetes?*
- Yes (please bring a copy of your child’s Diabetes Management Plan to the workshop)
- No
(9) Please provide any details of serious illness, regular medication or medical procedures, or allergies here. Is there any other health information that we need to know?
I authorise SPUFC Holiday Clinic coaches and staff to seek urgent medical, dental, or hospital treatment, which may include transport by ambulance, should my child be injured during the SPUFC Holiday Clinic.*
- Yes
I agree that photographs and videos taken during SPUFC Holiday Clinics, may be used by SPUFC for promotional purposes, in general group situations and without names being associated with those photographs and videos. Promotional methods may include newsletters, website or social media platforms, and flyers. Approval will be sought from parents for the use of any photographs or videos that depict individuals.*
- Yes
- No
Please provide any additional information that will assist SPUFC Holidays Clinics to meet your child’s needs while participating in activities.
Cost
Select your attending day
- First Day (10th of July)
- Second Day (11th of July)
Total
$ 0.00
Credit Card
Card Details
Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.

CONTACT US

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South Perth United Football Club.
Challenger Reserve,
Challenger Avenue,
Manning,
WA 6152
Email:
admin@southperthunitedfc.com.au

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Holiday Program

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Information Form – Confidential

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