ADELAIDE COBRAS SENIOR REGISTRATION FORM Welcome to the Adelaide Cobras Football Club, if you would like the opportunity to represent one of our 3 senior teams please complete the online registration form so you can be considered. We will endeavour to keep you up to date with all information regarding Senior Football.

SENIOR REGISTRATION FORM PLAYER PERSONAL DETAILS Please fill it out all the fields below in CAPITALS Players Full Name* Home Address* Suburb* Post Code* Email Address - LOWER CASE* Age* Date of Birth - dd/mm/yyyy Gender* Select one >>MaleFemale Occupation* Employment Status* Select one>>Self-EmployedUn-EmployedEmployedStudyingOther If self-employed - Trading Name MEDICAL DETAILS Please tick if you suffer from any of the following listed below. Please tick Allergies Asthma Back Problems Blood Disorders Diabetes Dizzy Spells Epilepsy Fainting Heart Condition Muscular Disorders Other - Give as much information as possible. PLAYER FOOTBALL DETAILS Please list your football playing history. Season Registering for?* Select one>>201220132014Other Playing Group Applying for* Select one>>Seniors - Under 19Seniors - ReservesSeniors - First Team Most recent competition played in Select one>>FFSA JPL/JSL Under 15- 17Under 19 - State LeagueReserves - State LegueFirst Team - State LeagueUnder 19 - Premier LeagueReserves - Premier LeagueFirst Team - Premier LegueUnder 19 - Super LeagueReserves - Super LeagueFirst Team - Super LeagueInterstateOverseasNever Played Club FootballOther FFA Number - If Known Current Club List Previous 2 Clubs Previous Club No 2 Playing Position Would you be interested in Coaching or Assisting a Junior team?* select one>>Development 4-6ysUnder 7Under 8Under 9Under 10Under 11Under 12Under 13Under 14Under 16Under 17Under 11 GirlsUnder 13 GirlsUnder 15 GirlsUnder 17 GirlsNoNot at this stage Please select a coaching option Coach Assistant Coach Trainer Team Manager PARENT, GUARDIAN Please complete if your child is under18 years of age,. Registering Select one >>>I am registering him as a Senior Player Contact Person Relationship to Player Select one>>FatherMotherStep-FatherStep-MotherUncleAuntyGrand ParentBrotherSisterOther Home Phone (Area Code) Mobile Number Email Address - LOWER CASE If an error occurs which does not allow you to submit this form please contact our webmaster at communications@adelaidecobras.com.au Please enter the phrase as it is shown in the box above.