Find out more about the World's Number 1 Soccer Skills Method.

GOCARDLESS

Please complete this registration form to authorise Coerver Coaching Leinster to collect direct debit in accordance with services used.

No payments will be taken today.

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Parent Details

Name*

Address*

Phone*

Emergency Contact*

Email*

Costs

Select Your Programme*

All programmes are billed monthly via GoCardless payment platform. Please select 1 or 2 players below for the relevant programme.

Player Details

Player Name*

Player Current Club & League*

Coerver Academy Location*

Player Preferred Position*

Player Date of Birth*

Player Medical Information*

Any Other Info*

How Did You Find Out About Us?*

Players 2 Details

Player 2 Name*

Player 2 Academy Location

Player 2 Current Club & League*

Player 2 Preferred Position*

Player 2 Date of Birth*

Player 2 Medical Information*

Player 2 Any Other Info*

Players 3 Details

Player 3 Name*

Player 3 Academy Location

Player 3 Current Club & League*

Player 3 Preferred Position*

Player 3 Date of Birth*

Player 3 Medical Information*

Player 3 Any Other Info*

Coerver Adidas Kit

A full Coerver Adidas Kit (Jersey, Shorts & Socks) can be purchased for an additional €35 per player. Please click ‘Yes’ below if you would like to purchase this, and then select what size you would like from the dropdown. Please click ‘No’ if you would not like to purchase it. If yes, the €35 will be added onto your direct debit for the first month per player.

Would you like to order kit?

Yes

Player 1

Player 2

Player 3

Total Billable Per Month*

Additional Kit fees may apply.

Total Billable

Performance Academy Total Value

Image Consent*

We may take photos/videos in the academies for use on our social media. Do you consent to the use of these images which may contain your child in them on our platforms?

Yes

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