Junior Cup Registration

X/Twitter

This field is for validation purposes and should be left unchanged.

Player Details

Name(Required)

First Last

Date of Birth(Required)

Medical Conditons(Required)

Yes

No

Medical Condition Details(Required)

Tournament Option(Required)

Emergency Contact Information

Parent/Guardian Name(Required)

First Last

Phone(Required)

Email(Required)

Acknowledgement & Payment

Media Permission(Required)

I give permission for Launceston City Football Club and the applicable tournament governing body to photograph, film and otherwise record the child or children named on this form, and to use that media for future promotional purposes.

Yes

No

Total

Credit Card

Cardholder Name

Card Details

Junior Cup Registrations