FROGS All-Star Basketball Registration
4 week program for Term 3 2017
Dates starting: Monday 31st July, 7th August, 14th August and 21st August
Time: 5:00pm - 5:45pm
Cost: $8 per additional session includes a FREE basketball when attending all sessions; pre-payment is required to organize the coaches required
Participant First Name *
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Participant Surname *
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Date of Birth *
MM
/
DD
/
YYYY
Parent / Guardian Name *
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Mobile *
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Email *
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Medical Conditions / Notes
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School *
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Dates Attending *
Required
Payment Options *
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Parent Declaration
Please note that by submitting this registration you agree to the following. I the parent/guardian of the above named child give permission for him/her to participate in these clinics. In the event of any illness or incident where it is impractical to communicate with me, I authorize the organizer / coaches, on my behalf, to seek medical assistance as my child may require, including ambulance travel, anaesthetic, blood transfusion and surgical procedures. I accept responsibility for payment of any expenses incurred. I acknowledge that my child may be injured in the course of the clinics and I understand and voluntarily accept the risk and agree that I will not hold the organizer / coaches to be liable for any injury including without limitation, personal, bodily or mental injury and economic loss. If there is any claim in relation to my child based on an injury, I agree to indemnify the organizer / coaches for all liabilities resulting from such claims. I agree to my child’s photo being used for promotional purposes.
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