ENROL June 4, 2017 admin Player DetailsName*Date of birth*Program*[Please Select]Player Technical Development (Mondays)Player Technical Development (Saturdays)School ClinicsAdvanced Programs (Invite Only)Choose Venue (School Holidays)*[Please Select]Port PirieChoose Age*[Please Select]Reception to Year 3Choose Venue (School Clinics)*[Please Select]Saint Ignatius CollegeImmanuel CollegeGrange Primary SchoolSt Peter's CollegeChoose a Term (Saint Ignatius College)*[Please Select]Term 1Term 3Choose a Term (St Peter's College)*[Please Select]Term 3 | Mondays 3.15pmChoose a Term (Immanuel College)*[Please Select]Term 1 Fridays | 14 Feb - 3 Apr | 3:30 - 4:30pmTerm 3 Fridays | 31 Jul - 18 Sep | 3:30 - 4:30pmChoose a Term (Grange)*[Please Select]Term 1 Wednesdays | 12 Feb - 1 AprAcademy*Reception - Year 1 $160 Note: 8 Weeks session - 55 min session - Staring Date Saturday 13th October-Time 9.00am-9.55amYear 2-4 $160 Note: 8 Weeks session - 55 min session - Staring Date Saturday 13th October-Time 10.00am-11.00am1 FREE Trial - Starting Date 6th October 9.00am-10.00amChoose your Age (Advanced Programs)*[Please Select]Ages 9-11 | Tuesdays | Campbelltown SC | 7.15-8.15pm | $200Ages 12-15 | Thursdays | Campbelltown SC | 6-7pm | $200 Please note, in Term 4 sessions will be run at both Campbelltown SC and Vipers FC - you can select your venue of choice below. The sessions run and the price are the same for both venues.Choose a Term (Advanced Program | Ages 9-11)[Please Select]Term 1: 11 Feb to 31 MarTerm 2: 28 Apr to 16 JunTerm 3: 21 Jul to 8 SepTerm 4: 13 Oct to 1 Dec (Campbelltown SC)Term 4: 13 Oct to 1 Dec (Vipers FC)ALL TERMS (1-4) - 20% DiscountChoose a Term (Advanced Program | Ages 12-15)[Please Select]Term 1: 13 Feb to 2 AprTerm 2: 30 Apr to 18 JunTerm 3: 23 Jul to 10 SepTerm 4: 15 Oct to 3 Dec (Campbelltown SC)Term 4: 15 Oct to 3 Dec (Vipers FC)ALL TERMS (1-4) - 20% DiscountChoose your Age (Player Technical Development)*[Please Select]6-8: Mondays | Vipers FC (St Clair) | 6-7pm | $1809-11: Mondays | Vipers FC (St Clair) | 7.15-8.15pm | $180Choose a Term (Ages 6-8)[Please Select]Term 1: 10 Feb to 30 MarTerm 2: 25 May to 29 JunTerm 3: 20 Jul to 7 SepTerm 4: 12 Oct to 30 NovALL TERMS (1-4) - 20% DiscountChoose a Term (Ages 9-11)[Please Select]Term 1: 10 Feb to 30 MarTerm 2: 25 May to 29 JunTerm 3: 20 Jul to 7 SeptTerm 4: 12 Oct to 30 NovALL TERMS (1-4) - 20% DiscountChoose a Term (Ages 12-14)[Please Select]Term 1: Starts Tuesday 12 Feb - Finish Tuesday 9 AprilTerm 2: Starts Tuesday 7 May - Finish Tuesday 2 JulyTerm 3: Starts Tuesday 30 July - Finish Tuesday 24 SepTerm 4: Starts Tuesday 15 Oct - Finish Tuesday 10 DecALL TERMS (1-4) - 20% DiscountChoose a Term (Ages 12-17)[Please Select]Term 1: Starts Thursday 14 Feb - Finish Thursday 11 AprilTerm 2: Starts Thursday 9 May - Finish Thursday 27 JuneTerm 3: Starts Thursday 1 Aug - Finish Thursday 19 SepTerm 4: Starts Thursday 17 Oct - Finish Thursday 5 DecALL TERMS (1-4) - 20% DiscountPlayer Technical Development All TermsPTD: ALL TERMS - All agesAdvanced Programs All TermsAdvanced Programs: ALL TERMS - All agesChoose your Age (Saturday Clinics)*[Please Select]Ages 6-8 | Campbelltown SC | 9-10am | $180Ages 9-11 | Campbelltown SC | 10.15-11.15am | $180Choose a Term[Please Select]Term 1: 8 Feb to 28 MarTerm 2: 2 May to 20 JunTerm 3: 25 Jul to 12 SepTerm 4: 17 Oct to 5 DecALL TERMS (1-4) - 20% DiscountSaturday Clinics All TermsSaturday Clinics: All TermsChoose your Age (Kilburn Sports Complex)*[Please Select]6-12: Kilburn Sports Complex - Time: 9.00 to 12.00 pm - Price $150Choose a Term (Ages 6-12)[Please Select]Term 2/3: Tuesday to Thursday - 9 to 11 JulyTerm 3/4: Tuesday to Thursday - 1 to 3 OctoberChoose your Age (Port Pirie)*[Please Select]8 to 10: Time: 10am to 11:15am11 to 12: Time: 11:30am to 12:45pm13 to 15: Time: 2pm to 3:15pmChoose a Session (Port Pirie)*[Please Select]3 days: 15-17 July - Price $1601 day: Price $60Choose a Term (Ages 9-11)[Please Select]Term 1/2: Tuesday to Thursday - 24 to 26 AprilTerm 2/3: Tuesday to Thursday - 16 to 18 JulyTerm 3/4: Tuesday to Thursday - 8 to 10 OctoberChoose your Training Kit Size[Please Select]'Gioca' Training Kit $50 (presented at 1st session)I already have the training Kit from previous sessions Please note, we are pleased to announce 'Gioca' as our training kit brand partner for 2020. The training kit is a new style from the old so for past players with the old kit, be sure to check out the new one!Parent/Guardian DetailsName*Contact Number*Email* Further Player DetailsConfidential Medical InformationNoneAllergiesAsthmaDiabetesEpilepsyHeart ConditionOtherSpecify OtherMedical Assistance In the unlikely event of an emergency I authorise the staff of Marcelo Carrusca Football Academy to seek and/or perform appropriate medical attention. Media Release I give permission for the player's name which appears on this registration form to be photographed and/or filmed while enrolled in soccer programs with Marcelo Carrusca Football Academy. I understand that when such photos or videos are posted on the website or used for marketing purposes they will be used in accordance with the Privacy Act (1988). Payment Method*EFT/Credit CardPayPalCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Do you have another child registered in the Carrusca Football Academy?[Please Select]YesNoGreat! Siblings are eligible for a 20% discount. Simply use the code SIBLING20 below to activate.Apply coupon or code Total $ 0.00 I agree to the Academy terms & conditions.