2013 Japan Tour(Open to 14, 15, 16, 17 year Old's)

19 Sept – 2nd Oct 2013 – School Holidays

How would you like the opportunity to:         1. Play against J league Youth Teams2. Play in exceptional facilities3. See what the real professional scene is like4. See what it takes to become a professional footballer5. Gain some great training tips to help you to succeed at the

highest level in football or in the areas you wish to follow6. Experience the great culture of the Japanese

Cost Includes:Flights, Insurance, Accommodation, Food, All Travel in Japan, Sightseeing, Training and Playing Gear

At no extra cost for those travelling we will:7. Take the time early in the season to assess the individuals

performance and give feedback8. Spend one on one time helping the individual improve in

their game leading into the tour9. This will help them prepare for the demands of playing

many games against exceptional players – Approx.: 12 games in 14 days

Cost of Tour:$5000.00

Life skillsWhile on tour we will also run a number of life sessions to help individuals sharpen their skills to tackle any challenges they may face in life. We believe that how you act off the park is how you act on the park.

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TOUR TO JAPAN SEPTEMBER 2013 INFORMATION REQUIRED

CONSENT FOR INTERNATIONAL TRAVEL

We/ I , and , declare that we are the lawful Guardian/s of, (Players Name) , born (date) at (place of Birth) , (Country) , carrying a (Country), passport numbered , which was issued on, (date) , at, (place) . Our child, ,has my/our consent to travel with Allen J ohnstone, kick4goals PTY Ltd of 5 Calendonian Cres, Brisbane, Queensland to visit J apan. My/our child will be leaving Coolangatta, Australia on, 19th September, 2013, and returning to Coolangatta, Australia on, 1st October, 2013. In the event that my/our child requires emergency medical treatment and I /we cannot be reached, Allen J ohnstone is authorized to consent to medical treatment in my/our stead. Signature of Parent/Guardian: Printed Name: Date: Signature of Parent/Guardian: Printed Name: Date:

TOUR TO JAPAN SEPTEMBER 2013 INFORMATION REQUIRED

Players Medical Consent Form Note: This form is to be filled in by the Parent or Guardian of any player attending the overseas tour of J apan with Kick4goals PTY Ltd departing from Coolangatta International Airport on, 19th September 2013 and returning to Coolangatta International Airport on 2nd October 2013. The information contained herein is required by medical Practitioners in the event of any player requiring treatment. This information given here is not intended to stop a player from playing. I t is important for the wellbeing of the player that this form be completed fully and accurately. Players Name: D.O.B: Address: Name of Parent/Guardian Telephone Number: Home: Work: Mob: Name of Medical Insurance Fund: Medicare No Has your child had a tetanus booster in the last 12 months: Yes/No Does your child suffer from any of the following? Please give full details including severity, medication, date of last attack, operation etc. Heart Problem

Respiratory Problems

Asthma

Blood Pressure

Diabetes

Epilepsy

Bed Wetting

Phobias

Recent I llness/Operations: Allergies to: Food

Drugs

Ointments/Bandaids

Others

Medication: Please give details of any medication being taken by your child including dosage, frequency etc. The medication(s) listed below has/have been prescribed for my son by a registered medical practitioner and will be required to be administered while my child is attending the 2013 J apan Tour. I hereby request the coaches accompanying the players on tour can administer the medication(s) in accordance with the instructions written on the medication container(s) by the pharmacist in accordance with the medical practitioner’s instructions. We understand that all unused medication(s) will be returned to me. Name of Parent/Guardian: Signature of Parent/Guardian

TOUR TO JAPAN SEPTEMBER 2013 INFORMATION REQUIRED

MEDICAL PRACTITIONER Family Doctors Name: Address: Telephone No: NAME OF MEDICATION DOSAGE TIMES FOR

ADMI NI STRATION

TOUR TO JAPAN SEPTEMBER 2013 INFORMATION REQUIRED

Player Permission Form To be signed by player and if under 18 years of age by parent or Legal Guardian Player Name:  Age:  I give permission to the kick4goals PTY Ltd to use my image, sound and/or my name for Media activities to promote the kick4goals PTY LtdFuture media activities which would assist with further promoting Kick 4 Goals PTY Ltd. I understand that by giving this permission, that kick4goals PTY Ltd can use my image, my sound/or my name in any way it chooses, for the purposes described above. It may reproduce them in any form, in whole or in part, and distribute them by any medium including internet, CD-ROM, or other multimedia formats. I understand that I will not be paid for giving permission.  Players Signature: Date:  If under 18, parent/Legal Guardian:

Please Print

 Parent/Legal Guardian Signature: Date: 

TOUR TO JAPAN SEPTEMBER 2012 INFORMATION REQUIRED

What is require from you

1. All above documents completed and signed by parent or Guardian if under 18 years of age.

2. A photocopy of players passport (passport name, number and photo). This is to ensure that all details are correct on the ticketing.

Please Scan all documents and email to kick4goals@hotmail.com or print and send to: Allen J ohnstone 5 Caledonian Crescent Alexandra Hills Brisbane 4161 Queensland Australia