Fill Out Information Below To Register With Prodigy Athletics
Athlete Details
*ATHLETES* Name
*
First Name
Last Name
Athletes DOB
*
/
Day
/
Month
Year
Athletes Phone Number
Athletes E-mail
Gender
*
Female
Male
Athletes Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent / Emergency Contact
*
First Name
Last Name
Contact Number
*
Contact E-mail
*
Parent / Emergency Contact 2
First Name
Last Name
Contact Number
Contact E-mail
Are you committed to training within all of the term dates supplied in the Handbook?
*
Yes
No
How Many Teams Are You Accepting From Your Team Placements?
*
1 Team
2 Teams
3 Teams
Would you like Unlimited Access to all Additional Classes? ($20pw See 'Extra Classes' in the Handbook for more info)
*
Yes
No
If "No", please list the holiday dates below for approval. Please note that being unavailable during term training dates may affect your spot on the team.
Athlete Medical Details
Any Medication / Medical Conditions or areas of concern?
Ambulance Cover
*
Yes
No
Adhesive Allergy (Band-aid, Tape etc)
*
Yes
No
Payment Options
*
Weekly Direct Debit - Recurring weekly invoices will be sent to the email address provided below. Please save your card details to ensure seamless automatic payments each week.
Up Front Term Fee - An invoice for the full term fee will be sent to the email address provided below. This invoice must be paid in full before the start of the term.
Email To Receive Invoices
*
Confirmation Email
example@example.com
Waiver / Terms & Conditions
Must Read / Scroll to check the box.
*
Todays Date
*
/
Day
/
Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Choose Below
*
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Registration
$150.00 AUD
$
150.00
AUD
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
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