GAME READY Single Day Soccer Clinic Penola
TONY O'CONNELL OVAL Registration form
Personal Information
Person Responsible for the child
Parent/Caregiver Name
*
First Name
Last Name
Email
*
example@example.com
Age Group
*
9-11 Year Old
12-14 Year Old
Select Day:
Wednesday 8th October (9:30 - 2:00pm)
Player details
*
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
Back
Next
My Products - 9:30 - 2:00pm
*
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next
( X )
Age Selection
$
55.00
AUD
Quantity
Price
Age 9-11
1
2
3
4
$
55.00
AUD
Age 12-14
1
2
3
4
$
75.00
AUD
Item subtotal:
$
0.00
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit registration
Should be Empty: