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Athlete's Details		Parents'/Guardians' Details
Athlete's First Name:		Mother's Name:
Athlete's Last Name:		Mother's Email Address:
Date of Birth:		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:	n/a Australian Rules Football Baseball Basketball Cricket Cross Country Cycling Dance Dragon Boat Racing Fencing Field Hockey Figure Skating Football (Soccer) Futsal Golf Gridiron Gymnastics Ice Hockey Lacrosse Martial Arts Motorsport Mountain Biking Netball Rowing Rugby League Rugby Union Running Snow Skiing Snowboarding Surf Life Saving Surfing Swimming Table Tennis Taekwondo Tennis Touch Football Track & Field Triathlon Volleyball Water Polo Water Skiing Weightlifting Wood Chopping

Training Dates: From 09-Oct-09 To 27-Nov-09

Training Days & Times:
Please select up to 2 sessions.
Once a time slot is full you will be asked to make another choice.

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.