2022 Club Membership Registration Form

2022 Club Membership Registration Form

Complete the form below to sign up for our membership service.
Athletes Name *

First Name Last Name
Athletes Mobile Number: *

Area Code Phone Number
Athlete Email: *
example@example.com
Athletes Birth Date: *

Month Day Year
Athletes Age as of Dec 31 2022 *
Athlete address (Suburb only): *
How did you hear about us? *

Social Media I am a current/past athlete Google/Search Engine Event (Allstar Competitions) Word of mouth
If referred by a current or past PA Athlete please let us know who below so we can thank them!
Student ID (Deakin uni cheer/dance students only)

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Cancel of

Athlete Medical Details
Have you received the COVID-19 Vaccination? *

Yes, I am considered fully vaccinated I have received 1 dose of the COVID-19 vaccination I have a medical exemption No
What was the date of your last COVID-19 Vaccination?

Month Day Year
Date
COVID-19 Vaccine Certificate OR Medical Exemption

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Cancel of
Ambulance Cover *

Yes No
Bandaid Allergy *

Yes No
Medication or Allergies
If Applicable
Other Medical History, Areas of concerns
If Applicable
Private Health Fund Name & Number
If Applicable

Payment Details

Card listed will be used for the Registration payment upon submitting form and future membership payments.
Once the Registration Fee has been processed, a receipt will be sent to the Parent/Guardian #1 email address.

An invoice will be sent for the first monthly payment, upon receiving the invoice please select 'Save my card for future payments' to allow for automated payments for the 2022 season. Note: If this option is not selected there will be an additional $25/month admin fee to manually process payments moving forward.

Any credits remaining from the 2021 season will be applied to your first months invoice.

Registration Fee $ 90.00 AUD

Enter coupon

Total $ 0.00 AUD

Team Confirmation