Bola International Cup 2023 2023 Bola Bali Cup – Player Registration This registration form is for players invited to participate in the 2023 Bola Bali Cup. Please complete all fields to confirm acceptance of your invitation for 2023. Player detailsPlease enter the player's details below, as it appears on their passport.Full Name(Required) First Middle Last Date of Birth(Required) DD slash MM slash YYYY Parent/Guardian detailsPlease enter details of parent or guardian responsible for participant.Parent/Guardian - Name(Required) First Last Parent/Guardian - Email(Required) Parent/Guardian - Mobile(Required)Participant - Medical informationPlease provide details or any relevant medical or dietary information.Does the player suffer from any of the following medical conditions?(Required) No - The player does not suffer from any medical conditions Respiratory Problems Diabetes Headache/Migraines Skin Problems High Blood Pressure Epilepsy Eye/Ear problem Emotional Illness Asthma/Bronchitis Allergies (mild - severe) Digestive Disorder Other (specify below) Please specify medical details(Required)Medicare number(Required) Do you have private health cover?(Required) Yes No Private health - Provider name(Required) Private health - Member number(Required) Will the player require regular medication during the tour?(Required) Yes No Please specify details of medication(Required)Date of last tetanus vaccination (if known)MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Does the player have any special dietary requirements?(Required) Yes No Dietary Requirements(Required)List N/A if not applicable Please include any extra medical or dietary information that may be of assistanceApparelOn payment of your deposit, you will be forwarded a link and a voucher code from Football West once the online shop is arranged. The order will also include your off field apparel. With your order please ensure that you enter the correct squad number that will be provided to you. This will be used for your match day kit. Emergency contact detailsEmergency contact - Name(Required) First Last Emergency contact - Mobile(Required) Emergency contact - Email(Required) Payment and consentBola Bali Cup - Deposit Price: The deposit of $500 is non-refundable. Total cost of the tour for 2023 is $2,850 (inclusive of GST). The remaining balance ($2,350) will be invoiced by Football West. Final payment will be due approximately 4-6 weeks before departure to the tournament. Payment details(Required)Card Details Cardholder Name Code of conduct(Required) I agree to the Football West Junior Touring Team Code of ConductConsent(Required) I hereby confirm that all information provided above is true and correct and give my consent for the player named above to attend the 2023 Bola Bali Cup and for Football West to seek and authorise medical or other assistance as may be required.