BROKEN HILL 'GAMEREADY' HOLIDAY CLINIC
Registration form
Personal Information
Parent/Guardian
Name
*
First Name
Last Name
Email
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Format: 0000 000 000.
RAA Member Number (if applicable)
Player Information
Age Group
*
10 - 15 Years Old - Friday, 17th April (10.00am - 2.30pm)
Player Details
*
First Name
Last Name
DOB
Do you give consent for the above player to have their photo taken across the GAMEREADY clinic? (will be used for social media advertising purposes)
*
Yes
No
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
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GAMEREADY HOLIDAY CLINIC
$
75.00
AUD
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Item subtotal:
$
0.00
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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