GRACIE BARRA TOWNSVILLE
SCHOOL HOLIDAY CAMP BOOKING
Are you aware this Camp is held at Gracie Barra Townsville?
*
Yes
No
Parent / Guardian
*
First Name
Last Name
Email
*
Address
*
Street Address
Street Address Line 2
Suburb
State / Province
Postal / Zip Code
Phone Number
*
Number of children attending?
*
1
2
3
4
5
Child 1
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First Name
Last Name
Date of Birth
*
/
Day
/
Month
Year
Date
Child 2
First Name
Last Name
Date of Birth
/
Day
/
Month
Year
Date
Child 3
First Name
Last Name
Date of Birth
/
Day
/
Month
Year
Date
Child 4
First Name
Last Name
Date of Birth
/
Day
/
Month
Year
Date
Child 5
First Name
Last Name
Date of Birth
/
Day
/
Month
Year
Date
Days attending:
*
Days each child will attend eg: John = Tue, Wed
Is there anything else we should know about your child? (This will be kept confidential amongst our staff).
Please explain in detail
Do you allow your child to be filmed and photographed for media purposes?
*
Please select the days and number of children:
Day 1
Wednesday 17th January
Number of Children
Total
Day 2
Thursday 18th January
Number of Children
Total
Day 3
Friday 19th January
Number of Children
Total
Grand Total
*
How did you hear about us?
*
Google
Facebook
Friend
TCC What's On
Other
Signature of Participant:
*
Signature of Parent/Guardian:
*
Payment Due
*
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Jiu Jitsu Summer Camp
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