Academy Training Program
Wollongong
Participant Full Name
*
First Name
Last Name
Date Of Birth
*
-
Day
-
Month
Year
Date
Parent Full Name
*
Mobile Number
*
Email
*
example@example.com
Suburb you live in
Emergency contact 1 - Full name and mobile number
*
Emergency contact 2 - Full name and mobile number
Does your child suffer from any medical conditions that might affect their participation?
*
Do you give consent for your child to be filmed for social media content?
*
Yes
No
Player Kit Size (new players only)
Please Select
X SMALL
SMALL
MEDIUM
LARGE
X LARGE
Jersey and shorts come in a YOUTH size set.
Bucket Hats are available as an additional purchase
Registration Fees
*
prev
next
( X )
New Player
Includes new kit
$255.00 AUD
$
255.00
AUD
Returning Player
$205.00 AUD
$
205.00
AUD
Black Hat
$16.00 AUD
$
16.00
AUD
White Bucket Hat
$16.00 AUD
$
16.00
AUD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
SUBMIT
Should be Empty: