Registration Form (Wentworth Falls)
For any questions or further information, please contact WWF@fcxsport.store
Student Name:
*
First Name
Middle Name
Last Name
Student Date of Birth:
*
-
Day
-
Month
Year
Example: 21-02-2010
Injury or Medical Condition:
Student Gender:
*
Female
Male
Other
If enrolling a child under 18 yrs:
Parent/Guardian First Name
Parent/Guardian Last Name
Email:
*
example@example.com
Phone Number:
*
Please enter a valid mobile number.
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where did you hear from us?
*
Please Select
Social Media
Google Search
Word of Mouth
Club Website / banners / signage
Flyer / Poster / Banner
Newsletter or Email
Community Noticeboard
Other
1. All fees must be paid by Due Date. If not paid within 7 days of the due date your position will be forfeited. No exceptions unless discussed with coach. 2. Payments may be made direct to coach or on-line (details for direct deposit listed on top of page); a receipt will be issued in due course. 3. Wet lessons will be made up at a time that is suitable for both the coach and students during the current term.
*
I agree
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