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Roma & District Junior Soccer Association

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Registration Form

Date of Birth - Child 1
Day
Month
Year
Date of Birth - Child 2
Day
Month
Year
Date of Birth - Child 3
Day
Month
Year
Address

Emergency Contact Information

Address

By signing and paying for registration, you acknowledge and agree to abide by the rules and directions given by the Roma & District Junior Soccer Association Office Bearers, Members and Referee’s.

Medical Information

I hereby consent to the provision of the following health information for Roma and District Junior Soccer Association’s records and to use in the event of injury, illness or emergency, if required.

Expiry Date
Day
Month
Year
Expiry Date
Day
Month
Year
Expiry Date
Day
Month
Year

Consent:

Volunteering:

Roma District Junior Soccer Association relies on volunteers to ensure continuing progress of junior soccer. If you can assist in any manner, please contact the secretary to nominate your interest.

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For further enquiries please feel free to email the Secretary at romajuniorsoccer@gmail.com 

GET IN TOUCH

Have questions or need more information? Feel free to contact Roma Junior Soccer. We're here to support our players and families on their soccer journey.

Tel: 0418 625 883     Email: romajuniorsoccer@gmail.com

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