Weekly Sessions

Athlete Details

Please ensure all details are correct and true
Athlete name*

First nameLast name
Athlete Date of Birth*

MonthDayYear
Date
Athlete Gender *
Athlete Year Level*
Athlete School*
Is the Athlete prescribed an inhaler? If yes, please describe instructions. Does the Athlete have any allergies, chronic illnesses, or medical conditions? If yes, please describe. (N/A if Not Applicable)*

Parent / Guardian Details

Please ensure the following details are correct and true.
Parent / Guardian Name*

First NameLast Name
Parent / Guardian Email*
example@example.com
Parent / Guardian Mobile number*
Please enter a valid phone number.
Emergency Contact Details

Please ensure the following details are correct and true.
Emergency Contact Name*

First NameLast Name
Emergency Contact Mobile Number*
Please enter a valid phone number.
Emergency Contact Relationship*

Playing Experience*
Has the Athlete attended an Impact Volleyball Event? (e.g. Youth Session / Camp)*

Yes - Loved it, back for more!No - Keen to get involved for the first time!
How did you hear about us?*

Payment and Confirmation
Products
prevnext( X )
Weekly Youth Session
$168.00AUD Quantity
Item subtotal:$0.00AUD

Total

$0.00AUD
You are about to register {athleteName} for {sessionTo} in {schoolTerm}
This is the correct session and I am happy to proceed*

YesNo
Disclaimer

To submit your registration, please read and agree to the following Policies and Procedures and Medical Release Authorisation.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

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Athlete Details