GIRLS Single Day School Holiday Clinic Mount Gambier, Casadio Park
Registration form
Parent/Caregivers Name
Name
*
First Name
Last Name
Email
*
example@example.com
Contact Number
*
Age Group
*
8-10 Year Old
11-15 Year Old
Select Day:
*
Monday 13th January (9:30am - 2:00pm)
Player details
*
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
Any further comment
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My Products - 9:30 - 2:00pm
*
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next
( X )
Age Selection
$
50.00
AUD
Quantity
Price
Age 8-10
1
2
3
4
$
50.00
AUD
Age 11-15
1
2
3
4
$
75.00
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: