TAMWORTH | NIAS FC Spring Holiday Clinic

NIAS FC | October School Holiday Clinic Tamworth

Registration form
The sessions will be delivered through activities centered around games-based approach and include agility, balance, speed and co-ordination activities. Sessions will include movement skills, technical and tactical components all in a safe and FUN environment which will aid the development of the player.
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Days : Monday 30th September to Friday 4th October
Age Group : 7-12 years (DOB 2012-2017)
Time: 8.30am - 12pm
Venue: Gipps Street GA6 field

Cost:
5 days = $160
3 days = $100

Cost for Subsequent child from same family : 
5 days = $100
3 days = $60
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*NB: Cancellations made less than 48hrs prior to day 1 of the clinic will be ineligible for refunds.
All cancellations must be made prior to 8:30am on Saturday 6th July so we are able to fill your place.

Please complete the following registration form for your child to join the NIAS FC School Holiday Camp.

Athlete Information
Child's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Gender*
Additional Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Gender
Additional Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Gender

Parent/Guardian Emergency Contact Details
Parent Name*

First NameLast Name
Parent Phone Number*
Please enter a valid phone number.
Parent Email*
example@example.com

Medical Details
Do you have any ongoing/chronic injuries?*
Any medical conditions?*
If yes, please specify.
Permission to call ambulance?*
Do you suffer from any known allergies?*
If yes, do you require an epipen?

Payment
Attending 3 day Camp, Please tick days attending:

MondayTuesdayWednesdayThursdayFriday

Purchase Sessions*

7-12yrs | 5 days Monday to Friday Product Image

7-12yrs | 5 days Monday to Friday

$160.00AUD Quantity

7-12yrs | 3 days Clinic Product Image

7-12yrs | 3 days Clinic

$100.00AUD Quantity

7-12yrs | 5 days subsequent child from same family discount Monday to Friday Product Image

7-12yrs | 5 days subsequent child from same family discount Monday to Friday

$100.00AUD Quantity

7 - 12yrs | 3 days subsequent Child from the same family discount Product Image

7 - 12yrs | 3 days subsequent Child from the same family discount

$60.00AUD Quantity

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Declarations
I DO / DO NOT* give permission for photographs of my child to be published in Northern Inland Academy of Sport social media and website content.
Should be Empty: