‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍Name:

Gender

‍‍‍Date Of Birth:

Adress:

Contact Number (WA):

Email:‍‍‍

Name Of Father

Phone Number Father:

Phone Number Mother:

Name of Mother

Any allergies, medications or other medical conditions we should be aware of:

Does the participant have medical insurance?

I acknowledge that I have / will transfer the monthly academy fee to the German Football Indonesia account:
CIMB NIAGA 7071 7077 6200

I acknowledge that participation in the football camp involves physical activities, and I assume all risks and hazards incidental to such participation. I hereby waive, release, and forever discharge the football camp, its directors, officers, employees, agents, and volunteers from any and all liability, claims, demands, or causes of action whatsoever arising out of any damage, loss, injury, or death to me or my child, while participating in the event.

I acknowledge that images and videos taken at the event may be used for promotion; including but not limited to press release; publicity materials including newsletters, magazines, brochures, websites and social media. Images and videos will not be accompanied by names or other personal details that could identify individual children or young people.  

Notes and comments: