Please enable JavaScript in your browser to complete this form.For kids aged 4-7, fantastic introduction to football, let them see if they love the game before committing to Miniroos and clinics. Fantastic value for 5 weeks @ $50 for new registrations and $25 for returning players Groups are capped at 20 kids per two instructors Dates: 10th February through to 10th March My Child's Name *FirstLastChild's date of birth *Child's Gender *MaleFemaleName *FirstLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryMobile Phone *Email *EmailConfirm EmailPreferred methods of contact *EmailSMSFacebookInstagramWhatsAppMedical conditions I want the Club to know aboutI am interested in volunteering asTeam ManagerCoachFirst AidOtherTo help the club get to know you, what are your occupations? *Comment or MessageAccident and Injury Disclaimer: Mooroolbark Soccer Club ("The Club") including any of its officers and/or members shall not be held responsible for any accident, illness or injury sustained while playing at, or attending any function with, The Club. I understand that The Club carries only basic player’s insurance (provided through registration with FV) and that it is my responsibility to arrange additional insurance cover. The Club recommends that every player takes out their own private health insurance. I also give my permission for The Club to arrange medical attention that may be deemed necessary including ambulance transport and I agree to pay for all such costs incurred ( emergency ambulance transport costs once paid can be claimed via player insurance ) The Club agrees that it will do its utmost to seek or obtain my and/or parental consent, if possible, prior to seeking medical treatment for me, but I understand and accept that it may not be possible to do so in the circumstances. The Club agrees to make every effort to contact my emergency contact/parent, where necessary and as soon as it is practicable to do so. Agreement: I hereby apply to be registered as a player of Mooroolbark Soccer Club. I agree to abide by the rules of the Club’s Constitution and FFA/FFV codes of conduct as a player/spectator. I will abide with the clubs code of conduct regarding interactions with club officials, parents, coaches and volunteers. *I have read and agree to the above conditions of membersPaymentIs this the first year your child has registered at the club? *YesNoFirst Time Registration *Summer Series 2022 - $ 50.00Summer Series 2022 - $ 50.00Summer Series 4-7 Thursday night 5.30 – 6.30 5 weeks Returning Registration *Summer Series 2022 - $ 25.00Summer Series 2022 - $ 25.00Summer Series 4-7 Thursday night 5.30 – 6.30 5 weeks Total$ 0.00Please Press Purchase Only Once *CardName on CardRich Text Visual Text Purchase