Online Form - Junior Coaching Registration » Victoria Park Leisure Centre

Leisurelife	Gym
Monday - Thursday	5:30am - 8:30pm
Friday	5:30am - 8pm
Saturday	8am - 6pm
Sunday	8am - 4pm

Aqualife	Gym	Pool
Monday - Friday	5:30am - 8:30pm	5:30am - 8:30pm
Saturday and Sunday	7am - 5pm	7am - 5pm

Child's full name*

Child's date of birth*

Parent/guardian full name*

Mobile Number*

E-mail*

Suburb*

Medical conditions - please note any medical, physical, or intellectual disabilities that would impact on the participant's learning ability

Coaching session selection*

Basketball 6-10 years old (Thu 4-5pm)
Netball 6-10 yrs old (Thu 4-5pm)
Soccer 6-10 yrs old (Fri 4-5pm)

Photographic consent - I give the Town of Victoria Park permission to take photographs of my child/ren participating in the activities which may be used on the Town website, social media and any promotional material distributed by the Town from this date forward. I hereby release and discharge the Town of Victoria Park from any and all claims arising out of the use of the above mentioned photographs*

YesNo