Northern Cobras Basketball Club Expression of Interest
Let us know you're interested in joining our new club! Please complete the details below.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child’s Details (additional section for more than 1 child)
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Child's Gender
*
Male
Female
Child's Full Name (If registering more than 1 child, otherwise leave blank)
First Name
Last Name
Child's Date of Birth
-
Month
-
Day
Year
Date
Child's Gender
Male
Female
Has your child ever played basketball before?
*
Yes
No
Preferred Competition
*
Craigieburn
Broady
Are you a Coach?
*
Yes
No
Submit Expression of Interest
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