Junior Squash Application Form 2013
Parent First Name *
Please enter parent first name
Your answer
Parent Last Name *
Please enter parent last name.
Your answer
Junior First Name *
Please enter junior first name
Your answer
Junior last Name *
Please enter junior last name.
Your answer
Junior Birth Date *
Please select the birth date of the junior
DD
/
MM
/
YYYY
Any Medical Condition / Medication which may affect the junior. *
Please specify any medical condition and/or medication which may affect your child.
Your answer
Contact number *
Please enter mobile or landline phone number.
Your answer
E-mail *
Please enter your E-mail address
Your answer
Address *
Please enter your address
Your answer
Payment options.
Please select the amount to be paid. This program is available to LLTC members only.
How did you hear about us?
Please tick whatever way your heard about us from list below.
Preferred time for coaching.
Please select your preferred time for coaching.
Please tick if you DO NOT want your child to be photographed/videoed
Photography or video during coaching sessions with your child in it maybe used by the club as marketing material on facebook, twitter, newspaper or the club website. Please tick the following box if you DO NOT want your child to be photographed.
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