HOLIDAY PROGRAM REGISTRATION

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Registration Form

Number of children attending

Participant's Name

GenderMaleFemale

Date of Birth (DD/MM/YYYY)

Second Participant's Name

Second Participant's GenderMaleFemale

Second Participant's Date of Birth (DD/MM/YYYY)

Third Participant's Name

Third Participant's GenderMaleFemale

Third Participant's Date of Birth (DD/MM/YYYY)

Fourth Participant's Name

Fourth Participant's GenderMaleFemale

Third Participant's Date of Birth (DD/MM/YYYY)

Address

Parent's Name

Mobile Number

Email Address

Emergency contact name

Emergency contact mobile number

Home club

Holiday Program LocationBallarat, VictoriaWarrnambool, VictoriaMorningside, QueenslandSurfers Paradise, QueenslandMelbourne, Victoria

Days Attending3 days (early bird offer $180)2 days ($160)1 day ($80)

Select which days will be attendedFriday and SaturdaySaturday and Sunday

Select which day will be attendedFridaySaturdaySunday

Media Release

I give permission for photographs / film to be used by Groundwork Coaching for promotion purposes

Have you attended GWC Holiday Program before?NoYes

Where did you hear about us?FacebookWebsiteReferral: Please provide detailsOther

Person you were referred by

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Final cost

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Summary

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Total :

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Cancellations

All cancellations must be made in writing at least two weeks prior to the commencement of the holiday program to info@groundworkcoaching.com.au to receive a full refund. Failure to comply with this timeline will make you ineligible for any reimbursement.