Borussia Academy Indonesia

Academy Registration:

‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍Full Player Name:‍‍‍

‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍‍Short Name:‍‍‍

Gender

‍‍‍Date Of Birth:

Jersey size (subject to. Availability)

Adress:

Contact Number (WA):

School:

Email:‍‍‍

Name of Mother

Phone Number Mother:

Name Of Father

Phone Number Father:

Any allergies, medications or other medical conditions we should be aware of:

Does the participant have medical insurance?

Program (sessions and payments):

I acknowledge to transfer the signup fee (IDR 1.000.000) and the program fee to the German Football Indonesia account: CIMB NIAGA 7071 7077 6200 and send the transfer slip via WA to +62 821 2117 1900.

Yes

I agree to wear the Borussia Academy Indonesia (BAI) outfit at all training sessions and matches. Football socks and other non-Borussia items should be in neutral colors (ideally black).

Please do not display Logos and Merchandise of other clubs and leagues beside Borussia Mönchengladbach and the Bundesliga.

Yes

I acknowledge that participation in the football academy involves physical activities, and I assume all risks and hazards incidental to such participation. I hereby waive, release, and forever discharge the football academy, its directors, officers, employees, agents, and volunteers from any and all liability, claims, demands, or causes of action whatsoever arising out of any damage, loss, injury, or fatality to me or my child, while participating in the events.

Yes

I acknowledge that images and videos taken may be used for promotion; including but not limited to press release; publicity materials including newsletters, magazines, brochures, websites and social media. Images and videos will not be accompanied by names or other personal details that could identify individual children or young people.

Yes

Notes and comments:

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