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basketball
Welcome
Hi there, please fill out and submit this form to your child to the upcoming basketball camp.
17
Questions
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1
Child's Name
*
This field is required.
First Name
Last Name
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2
Date of Birth
*
This field is required.
-
Date
Month
Day
Year
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3
Gender
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4
Guardian Name
*
This field is required.
First Name
Last Name
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5
Email
*
This field is required.
example@example.com
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6
Phone Number
*
This field is required.
Please enter a valid phone number.
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7
Permission to Photograph
*
This field is required.
Yes
No
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8
Does your child wish to order a lunch order?
Yes. Both Days
Yes. Thursday
Yes. Tuesday
No. I will bring lunch
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9
Days Attending Week 1
*
This field is required.
Tuesday the 18th of January: 10AM-2PM ($35)
Thursday the 20th of January: 10AM-2PM ($35)
Both Days ($65)
Not Attending Week 1
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10
Days Attending Week 2
*
This field is required.
Tuesday the 18th of January: 10AM-2PM ($35)
Thursday the 20th of January: 10AM-2PM ($35)
Both Days ($65)
Not Attending Week 2
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11
Optional Early Drop Off/ Late Pick Up- Tuesday the 18th of January
*
This field is required.
Early Drop Off- 9AM ($5)
Late Pick Up- 3PM ($5)
Both ($10)
Neither
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12
Optional Early Drop Off/ Late Pick Up- Thursday the 20th of January
*
This field is required.
Early Drop Off- 9AM ($5)
Late Pick Up- 3PM ($5)
Both ($10)
Neither
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13
Does your child suffer from any of the following?
Asthma
Epilepsy
Diabetic
Allergies
Other
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14
Other: Please state
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15
Any other important medical information?
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16
Terms and Conditions
*
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17
My Products
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My Bag
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My Bag
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Great Product Name
$20
Quantity:
1
Size:
Small
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Great Product Name
$20
Quantity:
1
Size:
Small
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Great Product Name
$20
Quantity:
1
Size:
Small
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Great Product Name
$20
Quantity:
1
Size:
Small
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ORDER SUMMARY
Total cost
AUD
Hot Chips
$
5.00
AUD
+
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Party Pie
$
0.80
AUD
+
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Quantity
Potato Cake
$
1.00
AUD
+
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Quantity
Chicken Nuggets x3
$
3.00
AUD
+
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Hot Dog
$
3.00
AUD
+
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Pie
$
4.00
AUD
+
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Sausage Roll
$
3.00
AUD
+
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Quantity
Nippy's Flavoured Milk
$
2.00
AUD
+
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Quantity
Iced Chocolate
Iced Honeycomb
Iced Strawberry
Iced Coffee
Iced Chocolate
Iced Chocolate
Iced Honeycomb
Iced Strawberry
Iced Coffee
Flavour
Up & Go
$
2.50
AUD
+
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Quantity
Banana
Chocolate
Strawberry
Vanilla
Banana
Banana
Chocolate
Strawberry
Vanilla
Flavour
Pop Top Juice
$
2.50
AUD
+
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Quantity
Orange
Blackcurrent
Orange
Orange
Blackcurrent
Flavour
Bottled Water (600ml)
$
2.50
AUD
+
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Bottled Water (750ml)
$
4.00
AUD
+
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Pepsi Max
$
3.50
AUD
+
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Gatorade
$
5.00
AUD
+
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Quantity
Berry
Blue Bolt
Grape
Berry
Berry
Blue Bolt
Grape
Flavour
Emma & Tom's Juice
$
4.00
AUD
+
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Quantity
Orange
Lemon
Raspberry
Orange
Orange
Lemon
Raspberry
Flavour
G-Active (Gatorade Water)
$
5.00
AUD
+
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Quantity
Berry
Lemon
Mango
Berry
Berry
Lemon
Mango
Flavor
Toastie
$
5.50
AUD
+
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Quantity
Ham & Cheese
Ham, Cheese & Tomato
Cheese & Tomato
Ham & Cheese
Ham & Cheese
Ham, Cheese & Tomato
Cheese & Tomato
Option
Croissant
$
5.50
AUD
+
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Quantity
Ham & Cheese
Ham, Cheese & Tomato
Ham & Cheese
Ham & Cheese
Ham, Cheese & Tomato
Option
Wrap
$
6.50
AUD
+
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Quantity
Chicken Salad (Chicken Breast, Tomato, Carrot, Cucumber, Lettuce, Red Onion, Mayonnaise)
Ham Salad (Ham, Tomato, Carrot, Cucumber, Lettuce, Red Onion, grated cheese, Mayo)
Chicken Caeser (Chicken Breast, Bacon, Cheese, Spinach, Caeser Dressing)
Chicken Salad (Chicken Breast, Tomato, Carrot, Cucumber, Lettuce, Red Onion, Mayonnaise)
Chicken Salad (Chicken Breast, Tomato, Carrot, Cucumber, Lettuce, Red Onion, Mayonnaise)
Ham Salad (Ham, Tomato, Carrot, Cucumber, Lettuce, Red Onion, grated cheese, Mayo)
Chicken Caeser (Chicken Breast, Bacon, Cheese, Spinach, Caeser Dressing)
Option
Foccacia
$
7.50
AUD
+
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Quantity
Chicken Schnitzel (Crumbed Chicken Breast, tasty cheese, Spinach, Sweet Chili, Mayo)
Ham, Cheese & Tomato (Virginian Ham, Tasty Cheese, Tomato, Tomato Relish)
Roasted Vegetables
Salami
Chicken Schnitzel (Crumbed Chicken Breast, tasty cheese, Spinach, Sweet Chili, Mayo)
Chicken Schnitzel (Crumbed Chicken Breast, tasty cheese, Spinach, Sweet Chili, Mayo)
Ham, Cheese & Tomato (Virginian Ham, Tasty Cheese, Tomato, Tomato Relish)
Roasted Vegetables
Salami
Option
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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