APPLICATION FORM – Estoril Elite Program

Name *

First

Last

Gender

Male
Female

Date of Birth: *

Country of Birth:

Nationality: *

Passport Number: *

Permanent home address:

Postal Code:

City

Country

Email *

Telephone nº

Mobile nº *

Correspondence address (if different):

Previous club

Position in the field

Goalkeeper
Defender
Midfield
Forward

Disability / Special needs (including dyslexia/medical conditions)

Proposed entry date

Elite Program Type

If you choose Online Program will answer the following 6 questions, otherwise go on to the finance question.

1 - Will you have internet access in your practicing spot?

2 - Preferred time of the day for practicing:

3 - Physical Condition

4 - Equipment Available

Ball
Goal
TRX
Heart rate monitor

5 - Available Space for Practice - If indoor

6 - Available Space for Practice - If Outdoors

Wall to play against
Goal
Grass floor
Concrete floor

Other floor type (Which?)

Finance: How will your program and maintenance be financed?

Self
Family
Sponsor
Other

Please note that if you are being sponsored by government/professional body, institution, company or club, you must provide a sponsorship letter. In case you will not pay for the Program yourself, please provide the name and address of the person/organization who will pay your fees.

Name