Sagake New Zealand Registration
Please fill out 1 form for each student.
Student Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Emergency Contact
*
First Name
Last Name
Relationship to Student
*
Emergency Contact Phone
*
-
Area Code
Phone Number
Allergies/Medical Conditions
Class Selection
*
J-Kids Class (5-8yrs) Tuesday 3:45 - 4:30pm
J-Kids Class (5-8yrs) Thursday 3:45 -4:30pm
Kids Class (9-12yrs) Tuesday 4:30 - 5:15pm
Kids Class (9-12yrs) Thursday 4:30 - 5:15pm
Youth Class (13-16yrs) Tuesday 5:30-6:30pm
Youth Class (13-16yrs) Thursday 5:30-6:30pm
Adults Class (16yrs +) Tuesday 7:00-8:30pm
Adults Class (16yrs +) Thursday 7:00-8:30pm
Payment type
*
Weekly Direct Debit (Thursday) please ensure you complete direct debit form on final page
Upfront (Not an option for Adult's sorry)
Upfront payment selection
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( X )
J-KIDS CLASS (1 class/week)
$
98.00
NZD
J-KIDS CLASS (2 classes/week)
$
140.00
NZD
KIDS CLASS (1 class/week)
$
98.00
NZD
KIDS CLASS (2 classes/week)
$
140.00
NZD
YOUTH CLASS (1 class/week)
$
119.00
NZD
YOUTH CLASS (2 classes/week)
$
168.00
NZD
Total
$
0.00
NZD
Our fee structure can be found here:
https://stridefitness.co.nz/fees
Signature
*
Submit
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