Toowoomba Basketball Strength and Conditioning Term 3

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Client 1 Details Parent/Guardian Details
Username Password
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Client First Name: Mother's Name:
Client Last Name: Mother's Email Address:
Date of Birth: Mother's Mobile/Cell:
Gender: Male Female Father's Name:
Email Address: Father's Email Address:
Confirm Email Address: Father's Mobile/Cell:
Home Phone: Do you have any injury concerns?
Address 1:
Address 2: Do you have any medical conditions?

Training Dates: From 10-Jul-2017 To 16-Sep-2017

Training Days & Times:
Once a time slot is full you will be asked to make another choice.

        Tue Fri
5:00 pm U/14 & U/12 55-57 Kitchener Street, Toowoomba $50
5:30 pm U/18 & U/16 55-57 Kitchener Street, Toowoomba $50

Prepayment required via Credit Card or PayPal.

I agree (Parent/Guardian):
Date: 23-Jan-2018
There are no refunds for any enrolments into Vision Exercise Physiology related programs. When you sign/tick confirmation for this enrolment you are acknowledging that you know this as a fact and have accepted it as a condition.
Payment Method:
Cost: $50.00
Total Cost: $50.00
Credit Card: Credit Card (Ezidebit)
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