fitzroy lions
inclusive soccer program

This program is designed for children with additional needs, disabilities or sensory needs. All are welcome!

Where: 110 Elizabeth Street, Richmond
When: Every Tuesday, 6-7 pm

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Player's name

First Name

Last Name

Date of birth

MM

DD

YYYY

Gender

Parent's details

First Name

Last Name

Email

Phone number

What are your child's support needs?

What soccer or other sport experience does your child have?

Are there any behaviours we should be aware of?

How does your child best communicate (verbally, visuals, Auslan, PECs cards etc)

Social media and photography consent

From time to time the club may wish to take photos or videos of players for use on social media to promote the club, or by our partners. Any imagery taken will be used solely for promotional purposes. Please tick below to indicate your agreement for pictures to be taken for the above reasons.

Yes

No

Any questions?

fitzroy lions inclusive soccer program

SIGN UP FORM

fitzroy lions
inclusive soccer program