KICKSTART Single Day School Holiday Clinic - West Beach Parks Football Centre
Registration form
*** BRING A FRIEND *** Personal Information
Person Responsible for the child
Name
*
First Name
Last Name
Email
*
example@example.com
Age Group
*
5-8 Year Old
Date Select
*
Tuesday 6th October 9:30am - 1:00pm
Player details
*
Player details
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
RAA Member Number (if applicable)
Where did you hear about the program?
*
Please Select
Social media
Email
Word of mouth
Radio
Tv adverts
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KICKSTART Single Day School Holiday Clinic - West Beach Parks Football Centre
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School Holiday Clinic
$55.00 AUD
$
55.00
AUD
Quantity
Price
Single Day Clinic
1
2
3
4
$55.00 AUD
$
55.00
AUD
Item subtotal:
$0.00 AUD
$
0.00
AUD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
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