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Ashgrove Acceleration - Semester 2, 2009

Do you already have a username and password to the Acceleration ESP Website? If you do, please enter them in the boxes provided below, then click "Load Details" to have your contact information loaded into this form. If not, please ignore these boxes.
Username (if known):
Password (if known):
Don't want to fill out this form online?
Click here to download a printable PDF copy of this form
Athlete's Details Parents'/Guardians' Details
Athlete's First Name: Mother's Name:
Athlete's Last Name: Mother's Email Address:
Date of Birth: Calendar Mother's Mobile:
Gender: Male Female Father's Name:
Athlete's E-mail Address: Father's E-mail Address:
Confirm Athlete's E-mail Address: Father's Mobile:
Athlete's Home Phone: Do you have any injury concerns?
Athlete's Mobile:
Address 1:
Address 2: Do you have any medical conditions?
Suburb/Town:
State:
Postcode: Favourite Sport:

Training Dates: From 14-Jul-09 To 22-Jan-10

Training Days & Times:
Please select up to 3 sessions.
Once a time slot is full you will be asked to make another choice.
There will be no sessions on the following dates: 12-Aug-09 , 25-Dec-09 to 08-Jan-10

Monday Tuesday Wednesday Thursday Friday
6:00am Snr 6:00am Snr 6:00am Snr 6:00am Snr 6:00am Snr
7.00am Snr 7.00am Snr 7.00am Snr 7.00am Snr 7.00am Snr
7.50am Jnr 7.50am Jnr 7.50am Jnr 7.50am Jnr 7.50am Jnr
3:30pm 3:30pm 3:30pm 3:30pm 3:30pm
3:50pm 3:50pm 3:50pm 3:50pm 3:50pm
4:15pm 4:15pm

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 ESP 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 ESP, 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.

I agree (Parent/Guardian): Date: 03-Sep-10
There are no refunds for any enrolments into Acceleration ESP 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.
Payment Method:
Cost: $221.00 (Semester 2) Boarders - Year 10-12
$125.00 (Semester 2) Boarders - Year 5-9
$259.00 (Semester 2) Day Student - Year 10-12
$155.00 (Semester 2) Day Students - Year 5-9
$130.00 (Term 3/4) Boarders - Year 10-12
$85.00 (Term 3/4) Boarders - Year 5-9
$150.00 (Term 3/4) Day Students - Year 10-12
$95.00 (Term 3/4) Day Students - Year 5-9
$95.00 Term 4 Day Student - Year 5-9
$70.00 Xmas Holiday Training
Cheque: Make cheque payable to Marist College - Ashgrove
Credit Card: Bank Card Visa Mastercard
Card No: CCV
Expiry: /
  
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