Flippa Ball Registration Form - Term 3, 2019 Years 4-6
Flippa Ball is a modified version of water polo played in shallower water to allow students to learn the basic rules of the game. In order to enjoy participating in Flippa Ball, students must be competent swimmers - your child's swimming ability will be assessed at school. Games are held on Sunday afternoons from 3.30pm at the Millennium Institute of Sport and Health, 17 Antares Place, Mairangi Bay.

The cost for Term 3 is $80.00, which includes pool time, pool hire and equipment for training at the Millennium Institute. Please complete this form and submit payment by Friday 21 June to secure a place. Places in these teams will be on a first-in-first-served basis and dependent on having willing coaches.

Fees can be paid by cash, cheque or eftpos at the school office and must be paid at the time of registration.
Online payment details: ASB Constellation Drive Branch Account No. 12 3042 0251645 00
Please note that we require a reference on all internet payments. Examples of a reference would be:
“J. Jones Y5 AO, Flippa Ball”

Email address *
Student's First Name *
Your answer
Student's Surname *
Your answer
I give my son/daughter permission to play Flippa Ball for Murrays Bay Primary School *
Student's Room / Teacher *
Parent / Caregiver Name *
Your answer
Parent / Caregiver Phone Number *
Your answer
Parent / Caregiver Email *
Your answer
Date Registration Fees Paid *
MM
/
DD
/
YYYY
I have paid $80.00 by: *
Required
Parent / Caregiver Volunteer Assistance *
Required
Full name of person offering to coach / manage
Your answer
Coach / manager contact phone
Your answer
Coach / manager email
Your answer
Binding Agreement: I have signed this form on my own behalf and on behalf of the student as a parent or in loco parentis. By submitting, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature. *
Required
Murrays Bay Primary School Contacts
Anthony Hyde - Sports Coordinator, Email: anthony@murraysbay.school.nz
Joanne Ouwehand - Sports Administration; Email: joanne@murraysbay.school.nz
A copy of your responses will be emailed to the address you provided.
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