Coomera Anglican College Speed Performance Program - Term #4, 2017

Don't want to fill out this form online?
Click here to download a printable PDF copy of this form
Group Bookings
How many people are there in your group?
Athlete 1 Details Parent/Guardian Details
Username Password
Load contact details Forgot Password
If you do not have a username and password, one will be created for you when you submit this form.
Athlete First Name: Mother's Name:
Athlete 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?
Mobile/Cell:
Address 1:
Address 2: Do you have any medical conditions?
Suburb/Town:
State/Prov:
Zip/Postcode:
Sport (if applicable):
How did you hear about us?

Training Dates: From 09-Oct-2017 To 27-Nov-2017

Training Days & Times:
Please select up to 14 sessions.
Once a time slot is full you will be asked to make another choice.
There will be no sessions on the following dates: 16-Oct-2017

Wednesday, 11-Oct-2017 07:00 AM to 08:00 AM Rod Lane Sports Centre
Wednesday, 18-Oct-2017 07:00 AM to 08:00 AM Rod Lane Sports Centre
Wednesday, 25-Oct-2017 07:00 AM to 08:00 AM Rod Lane Sports Centre
Wednesday, 01-Nov-2017 07:00 AM to 08:00 AM Rod Lane Sports Centre
Wednesday, 08-Nov-2017 07:00 AM to 08:00 AM Rod Lane Sports Centre
Wednesday, 15-Nov-2017 07:00 AM to 08:00 AM Rod Lane Sports Centre
Wednesday, 22-Nov-2017 07:00 AM to 08:00 AM Rod Lane Sports Centre

DISCLAIMER:
I hereby agree to assume all risks and responsibilities surrounding my (or my child's) participation in the program under the instruction of Acceleration coaches. I understand that similar to all sporting activities, there is a risk of damage to personal property, injury or death which may result from causes beyond the control of, and without fault or negligence of Acceleration, its officers, agents, or employees, during the period of my (or my child's) participation. I understand completely the above agreement and agree to be bound thereby. By registering on our site you agree that we may send you email related to our facilities and programs. We will not provide your details to any other company.

I agree (Parent/Guardian):
Date: 19-Dec-2017
There are no refunds for any enrolments into Acceleration 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: $91.00 1 Day per week (7 sessions)
$154.00 2 Days per week (All 14 sessions)
Total Cost: $0.00
Promo Code:
Credit Card: Credit Card (Ezidebit)
  
Enter security code: