1. NAME: ___________________________________________________________________
ADDRESS: __________________________________________________________________
SUBURB: ________________________________ STATE: __________ P/CODE: _________
TEL: ______________________________MOBILE: _______________________
2. Are you currently contracted as a Professional Player to any football club either in Australia or
overseas?
YES / NO (please circle)
If you have answered YES to Question 2 please provide details of your current contracted club and, in addition, attach a copy of any official correspondence granting permission for you to train with
Perth Glory FC:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY
Perth Glory FC takes no responsibility nor liability for any injury sustained, nor for any loss of income or medical expenses incurred as a result of any injury sustained during, prior to or post any trial or training session conducted by Perth Glory FC. All Trial / Train-On Players participate at their
own risk.
I have read and understand all of the above
____________________________ __________________________ ______________
Trial / Train-On Player Signature Print Name Date
____________________________ __________________________ ______________
Perth Glory FC Signature Position Date