NWJSA - PEGA CLINIC SKILL PROGRAM Term 2

Player Name

First NameLast Name

Date of Birth

Date

Gender

School Attending

Parent/Caregiver Name

First NameLast Name

Parent/Caregiver Email

example@example.com

Mobile Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

SuburbState

Post Code

Participant Conduct:

Respectful behaviour towards coaches, staff, other participants, and spectators is expected.

Unacceptable conduct, such as abusive language, violence, or disruptive behaviour, can lead to removal from the program with no refund.

Parents/guardians are expected to set a positive example and refrain from making inappropriate comments.

Liability and Indemnification:

Participants and their parents/guardians acknowledge the inherent risks involved in sports and agree to release the NWJSA and its volunteers from liability for injuries or damages.

Parents/guardians are responsible for ensuring their children are collected on time and may be asked to withdraw from the program if this is not done regularly.

Program Changes and Cancellations:

The NWJSA reserves the right to cancel or reschedule sessions due to unforeseen circumstances, such as weather or safety concerns, however this may not be possible due to a number of logistical factors ie: finding a suitable location, day and time to host the make up session

Changes to program schedules or locations will be communicated to participants.

https://nwjsa.org.au/

I hereby agree to the policies of the NWJSA Clinic Skills Program.

Select - Day and Location (Cost for One Session Per Week) for duration of Term 2

Prefer 'Girls Only' Clinic Program

Applying Sport Voucher

Player Medicare and Place Number on card (11digits) *Only needed if Applying

Sport Voucher - Coupon Code - Apply at Checkout
Term2SV

As Parent / Carer, Do you authorise NWJSA the use of player/s (child/ren) image for promotional purposes on our organisations official social media pages, including Facebook, Instagram, and our Website?

Parent / Caregiver Signature

My Products

Monday Session John Hart Reserve, Ethelton

4:00 to 4:45pm - Monday's

$108.00 AUD

Tuesday Session St Clair Oval 4

4:00pm to 4:45pm - Tuesday's

$108.00 AUD

Enter coupon

Total

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

NWJSA - PEGA CLINIC SKILL PROGRAM Term 2

My Products*

My Products