Acceleration

Coomera Anglican College Speed Performance Program - Term #4, 2017

Group Bookings

How many people are there in your group?

Athlete 1

Athlete Details

Athlete First Name

Athlete Last Name

Date of Birth

Gender

Email Address

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Create your password

Enter the password that you would like to use for your new account.

Confirm your password

Home Phone

Mobile/Cell

Parent/Guardian Details

Mother's Name

Mother's Email Address

Mother's Mobile/Cell

Father's Name

Father's Email Address

Father's Mobile/Cell

Address

Address 1

Address 2

Suburb/Town

State/Prov

Zip/Postcode

Health and Fitness

Do you have any injury concerns?

Do you have any medical conditions?

Sport (if applicable)

How did you hear about us?

Training Dates

From 09-Oct-2017 to 27-Nov-2017

Training Days & Times

Please select up to 14 sessions.
Once a time slot is full you will be asked to make another choice.
There will be no sessions on the following dates: 16-Oct-2017

Wednesday, 11-Oct-2017	07:00 AM	to 08:00 AM	Rod Lane Sports Centre
Wednesday, 18-Oct-2017	07:00 AM	to 08:00 AM	Rod Lane Sports Centre
Wednesday, 25-Oct-2017	07:00 AM	to 08:00 AM	Rod Lane Sports Centre
Wednesday, 01-Nov-2017	07:00 AM	to 08:00 AM	Rod Lane Sports Centre
Wednesday, 08-Nov-2017	07:00 AM	to 08:00 AM	Rod Lane Sports Centre
Wednesday, 15-Nov-2017	07:00 AM	to 08:00 AM	Rod Lane Sports Centre
Wednesday, 22-Nov-2017	07:00 AM	to 08:00 AM	Rod Lane Sports Centre

DISCLAIMER:
I hereby agree to assume all risks and responsibilities surrounding my (or my child's) participation in the program under the instruction of Acceleration coaches. I understand that similar to all sporting activities, there is a risk of damage to personal property, injury or death which may result from causes beyond the control of, and without fault or negligence of Acceleration, its officers, agents, or employees, during the period of my (or my child's) participation. I understand completely the above agreement and agree to be bound thereby. By registering on our site you agree that we may send you email related to our facilities and programs. We will not provide your details to any other company.

Agreement

Signed (Parent/Guardian)

Date

/ /

Payment Method

There are no refunds for any enrolments into Acceleration related programs. When you sign/tick confirmation for this enrolment you are acknowledging that you know this as a fact and have accepted it as a condition.

Cost

$91.00 1 Day per week (7 sessions)
$154.00 2 Days per week (All 14 sessions)

Cost Per Person

$0.00

Total Cost

Group Discount

Promo Code

Promo Code Discount

Grand Total

Credit Card (Ezidebit)

Please mail this form with a payment attached to: "Acceleration - Gold Coast, PO Box 37 Chirn Park 4215"