Enrollment Form

Student Details
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian
Parent/Guardian Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact
Emergency Contact Name
Emergency Contact Phone
Important Information

Fees: $80 / 4 weeks | Uniform $75 | Joining $50 | Annual $65

Direct Debit Only – setup link will be emailed after form submission

Closed on public holidays | Open during school holidays

MINIMUM CONTRACT TERM: 3 MONTHS

Insurance & Liability Students must have personal insurance. Club not responsible for injuries.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: