KICKSTART Single Day School Holiday Clinic - Summit Sport and Recreation Park
Registration form
Personal Information
Person Responsible for child
Name
*
First Name
Last Name
Email
*
example@example.com
Age Group
*
5-9 Year Old (single day)
Please select day:
Single Day - 16th April (9:30am - 1:00pm)
Single Day -20th April (9:30am - 1:00pm)
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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Single Day (5-9 Years old)
$
55.00
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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