SINGLE DAY SCHOOL HOLIDAY CLINIC
Registration form
Personal Information
Person Responsible for child
Name
*
First Name
Last Name
Email
*
example@example.com
Age Group
*
5-9 Year Old (single day)
Please select day:
Single day - 18th April (9:30am - 1:00pm)
Player details
*
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
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Single Day 18th April (5 - 9 Years Old ONLY)
one day only
$
50.00
AUD
Quantity
1
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5
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9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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