WPX Experience Camps - January 2022

Wellington Phoenix Experience Camps

Please complete the following form to register your child/children for the Wellington Phoenix Experience Camps - January 2022
Price

For two full days (9.00-15.00) $195 per child
Locations

Monday 17th & Tuesday 18th January - Trafalgar Park, Nelson

Registrations for our Nelson Camp are now closed

Thursday 20th & Friday 21st January - Halswell Domain, Christchurch

Monday 24th & Tuesday 25th January - Logan Park, Dunedin
Child Info
Name*

First NameLast Name
Date of Birth*
Gender*

MaleFemalePrefer not to say
Football Club
Does your child have any medical conditions that we should know about? Please specify any relevant medications that they may bring with them. (Please write 'nil' if none apply) *
Parent/Guardian Details
Your Name*

First NameLast Name
Email*
example@example.com
Mobile Phone Number*

PrefixPhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which WPX Experience Camp would you like to register your child for?*

Thursday 20th & Friday 21st January - Halswell Domain, ChristchurchMonday 24th & Tuesday 25th January - Logan Park, Dunedin
Emergency Contact (if different from above)
Name and contact number
Any additional information you think we should know.
I give permission for the Experience Camp staff to take photos of my child that may be used on Wellington Phoenix social media*

YesNo
I wish to receive communications from the Wellington Phoenix*

YesNo
Payment

An invoice will be sent to the email address provided. Payment in full is expected before the camp begins. Invoices will likely be sent out after January 10th.
By signing below, I agree not to bring any claim or proceeding against Wellington Phoenix, their sponsors, their employees and volunteers of the event for any damage, loss, injury or liability you or your child may suffer from participating from the event, within reason.

I consent to my child participating in this Holiday Programme.
Signature*

Clear
Date

MonthDayYear
Date
Any queries, please contact Jesse Rawlings at jesser@phoenixacademy.co.nz
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Wellington Phoenix Experience Camps