Winter Mentorship Rego Form
Join the Winter Mentorship Program (Term 2 - Term 3) >> Only 3 spots are available per session, so bookings are first-come, first-served.
Player Name
*
First Name
Last Name
Phone Number
*
Country Code- Area Code- Phone Number
Email
*
example@example.com
Date of Birth (dd/mm/yyyy)
*
School
*
Gender
*
Male
Female
Playing Level:
*
Intermediate
Advanced
Are you a Club/Reps player?
*
Yes
No
If "Yes", please list your Club/School/Reps team(s)
*
Select Your Preferred Training Venue:
*
Balgowlah Boys High School (Balgowlah, NSW)
German International School Sydney (Terrey Hills, NSW)
Northholm Grammar School (Arcadia, NSW)
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
Country Code- Area Code- Phone Number
Select Your Training Goal(s):
*
Build Skills & Fundamentals
Challenge & Motivation
Get a Routine
Get in shape
Select Your Playing Goal(s):
*
Get playing time
Score points
Get recruited
Build confidence
How did you hear about us?
*
Please Select
Friend Referred Me
Heart & Soul Hoops
International Sports Camps
Social Media
My School
Other
Did a Coach refer you? If yes, please select your Coach's name below:
*
Please Select
Coach Tom
Coach Paul
Coach Alex
Coach Gum
Coach Ben
Comment or Message
*
Submit
Should be Empty: