School Holiday Futsal Clinics
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Gender
*
Male
Female
Other
Parent Name
*
First Name
Last Name
Mobile Number
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Venue
*
Maclean Indoor Sports Centre
PCYC Grafton
Dates/Times (please select days player wishes to attend)
Wed 12/04 - 9am to 12pm (Grafton)
Wed 19/04 - 10:30am to 1:30pm (Maclean)
Fri 21/04 - 10:30am to 1:30pm (Maclean)
Is your child injury free & fit to participate
*
Yes
No
Fees: $45 per session
*
I commit to pay
I won't be attending
By selecting "Yes", I acknowledge that the information provided is true and correct. I also commit to attending the event as per the details above.
*
Yes
No
Payment - Please tick the box and select quantity of sessions.
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School Holiday Futsal Clinic
$
49.95
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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