MIRAGE SOCCER CAMP FORM
Weekend Football Training Session for kids between the ages of 5-18years of age.
Sign in to Google to save your progress. Learn more
MIRAGE SOCCER BOOTCAMP FORM
Full Name of Player *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Required
Position
Dominant Foot
Residential Address
Religion
Name of Parent/Guardian
Contact Number *
Occupation
Email *
Below are questions for the player...

Do you have any allergies/dietary issues?
If yes, state...
 *
Do you have any health challenges like Asthma, arthritis or sickle cell?
If yes, state...
 *
Name of guardian to accompany or pick up ward in your absence.
Contact number 
Registration Fee (Ghc1,400) 
Telecel Cash Number - 0200365903 
Account Name: Israel Sarpong Boateng Okyere.

Transaction ID for payment below
 *
Fee for Quarterly Payment (Ghc3000)
Telecel Cash Number - 0200365903
Account Name: Israel Sarpong Boateng Okyere

Transaction ID for payment 
Bank Account Details for payment
Fidelity Bank Account-(Mirage Football Academy Ltd)
Account Number: 1050050153016
Kindly enter payment reference below.
Choose the size of your jersey
Clear selection
Kindly tick if payment has been completed successfully Kindly call 0540924813 after submission of form. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Mirage football academy.

Does this form look suspicious? Report

Google Forms