AFL KiwiKick Online Registration Form
By completing this form you confirm that the information provided below is true and correct. You also agree to the AFL KiwiKick Terms of Participation. - http://aflnz.co.nz/afl-kiwikick-terms-of-participation/

AFLNZ takes care to ensure the confidentiality of the information provided on this application form and handles the information in accordance with the privacy principles set out in the Privacy Act.

Please make payments to AFL New Zealand. Internet Banking: 03-0283-0094878-00
As a reference please provide, 1. Child’s Surname 2. School / Play AFL Club Center

Participant Information
Given Name *
Your answer
Surname *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
School / Play AFL Club Center *
Parent / guardian contact details
Who is filling out the form? *
Given Name *
Your answer
Surname *
Your answer
Email address *
If you don;t have one, please type N/A
Your answer
Home Number *
Your answer
Mobile Number *
Your answer
Can you assist with any of the following
How will your child get home after AFL KiwiKick *
Required
Is your family happy to receive details on upcoming AFL KiwiKick programme and events that can assist with your child's club and school sports. *
Required
Medical
In case of emergency, provide alternate contact details
Emergency contact *
Emergency contact Name *
Your answer
Emergency contact Home Number *
Your answer
Emergency contact Work Number *
Your answer
Emergency contact Mobile Number *
Your answer
Does your child suffer from any illness, allergy or disability? *
If Yes - please provide details
Your answer
In an emerency, do you authorise the AFL KiwiKick Coorinator to arrange any necessary medical treatment for your child where proir notification has not been possible *
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