Kids Program Free Trial Request Form
Register for a Free Trial at any of our Kids Programs!
Child's Full Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
School Year Group
*
Gender
*
Male
Female
Parent/Guardian Full Name
*
Parent/Guardian's Email
*
example@example.com
Parent/Guardian's Mobile Number
*
Which Program Location? (If you would like to trial at multiple locations please submit the form again for that location.)
*
Cockburn CRC - Outdoor Beach [Monday] (5-6PM)
Providence Christian College - Indoor Hardcourt [Monday] (4:45-5:45PM)
Osborne Park - Indoor Beach [Tuesday] (4:45-5:45PM)
Port Kennedy - Indoor Beach [Tuesday] (4:50-5:50PM)
Canning Vale - Indoor Beach [Thursday] (5:30-6:30PM)
Wesley College - Indoor Hardcourt [Friday] (6-7PM)
Any Additional Information? (Allergies, Injuries, Conditions, ect.)
Submit
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