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 - OUT OF STOCK
SMALL
MEDIUM - OUT OF STOCK
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
Returning Player
$
205.00
AUD
Black Hat
$
16.00
AUD
White Bucket Hat
$
16.00
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
SUBMIT
Should be Empty: