PORT PIRIE SCHOOL HOLIDAY TRAINING CAMP - JANUARY
Registration form
SENATE ROAD COMPLEX
Personal Information
Parent/Guardian
Name
*
First Name
Last Name
Email
*
example@example.com
Age Group
*
5-10 Year Old (Tuesday 9th January 9.30am-1.00pm)
10-16 Year Old (Tuesday 9th January 1:00pm-4.30pm)
Player details
*
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
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Port Pirie Single Day Camp
*
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( X )
DATE SELECTION - Port Pirie Single Day Camp
Please buy a ticket for each registered player per date
$
50.00
AUD
Quantity
Price
JANUARY HOLIDAYS
1
2
3
4
$
50.00
AUD
Item subtotal:
$
0.00
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit registration
Should be Empty: