Child's First Name *

Child's Surname *

Attended a Playball Camp previously? Yes
No
*

Parent/Guardian's Name *

Address *

City *

State Victoria Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Western Australia

Postcode *

Date of Birth (DD/MM/YYYY) *

Age (yrs) *

School Attended *

Health Issues/Additional Information

Mobile *

Landline *

Email Address *

Playball Team ID & Name(if applicable)

Enter the characters as displayed

I hereby authorise Playball Basketball to act on my behalf should my child require medical attention and release Playball from any liability for personal injury, property damage or loss sustained as a result of his or her participation unless caused by the proven negligence of Playball Basketball. *

Thank you for registering for the upcoming holiday camp. To secure your place, please ensure payment is now made.

 Payment Method:

EFT to Playball Basketball

BSB: 063 136 Account: 10156640

Include words: ‘Camp’ and Child’s Name

 Credit Card

 Call 03 9585 6123 to pay by Visa or Mastercard