Holiday Clinic
Western Pride Football Club Holiday Clinic from Tuesday 26 September to Thursday 28 September - 9 am to 2 pm daily (3 days). Make sure you bring sunscreen, boots, socks, shin pads, lunch (money for lunch), hat.
Full Name *
Your answer
Gender *
Date of Birth (dd/mm/yyyy) *
Your answer
Email address *
Your answer
What school do you go to? *
Your answer
What club do you play for? *
Your answer
Do you have any Medical Conditions? *
Your answer
Emergency Contact details (name and mobile) *
Your answer
Payment Details
Please make payment of $200 before 25/09/17 or *$180 (Early bird rate) if paid before 13/09/17 to:
Western Pride Football Club
BSB: 124-150
A/C: 2210 6394
Reference: Put your first initial and last name for this (i.e. Pat Boyle would be PBoyle)
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