Child Name * Date of Birth *
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Parent/Career Name * Address
* Phone Number * Mobile * Email *
Emergency Contact Medical Condition (if any) Other Preschool Programs Attended By Child/Favorite Sports Siblings Attending Session (Name & Age) What Do You Want Your Child To Learn at Sporteka How Did You Find Out About Sporteka * Program Choice -------- Please Select -------- Tennis Multisport Day -------- Please Select -------- Sunday Monday Tuesday Wednesday Thursday Friday Saturday Preferred Time -------- Please Select -------- 9.15 am-10.00 am 9.30 am–10.15 am 10.00 am–10.45 am 10.15 am–11.00 am 11.00 am–11.45 am 11.30am–12.15pm 11.45am–12.30pm 12.15am–1.00pm 12.30pm–1.15pm 1.15 pm–2.00 pm 2.00 pm–2.45 pm 3.15 pm-4.00 pm 4.00 pm–4.45 pm Venue -------- Please Select -------- Aqualink, Box Hill Sportlink, Vermont South Heimat Centre, Doncaster East Pines Learning and Activity Centre, Doncaster East Koonarra Hall, Bulleen Start Date *
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Please state your 2nd and 3rd session preference in writing here Sporteka Logo T-Shirt Colour (Multisport Only) -------- Please Select -------- Blue Yellow Orange Red Green Hot Pink Add $30 to enrolment fee for a quality TEAM SPORTEKA Winter Hoodie (normally $35 if purchased through Sporteka Sports shop) Colours: Red or Grey or Pink <a href="/merchandise/" target="blank">(see merchandise)</a> -------- Please Select -------- Yes No Method of Payment -------- Please Select -------- Cash Bank Deposit (Bank details emailed on request) Personal Best Achievement Booklet Photo (Multisport Only). Please upload a photo of your child to be included on his/her special practice booklet Max. file size: 23 MB. About Enrolled Child: We want your child to make the most out of the Sporteka program, so any information regarding child’s personality, previous experiences, likes, dislikes that may help promote a positive entry into Sporteka is welcome. Refunds *
OPTIONAL: PHOTO CONSENT FOR SPORTEKA
I hereby give permission to Sporteka to take photographs and/or videotape of my child/children and consent that these may be used for promotional purposes of the Sporteka program in a manner that is not deemed adverse or defamatory to the person signing this form. Photographs /videotapes may also be used in the Sporteka website, Facebook page, YouTube, in the "Personal Best Achievement Booklet" and other handouts given to Sporteka participants including any future Sporteka instruction manual.
I HEREBY AGREE TO THE ABOVE MENTIONED TERMS AND GIVE PERMISSION TO SPORTEKA AS STATED:
Photo Consent -------- Please Select -------- Yes No Authorised by Name
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