MAMBA Camp with Julian Pesava

MAMBA Camp with Julian Pesava
REGISTRATION FORM

We are looking forward for your child to be involved in our first ever Mamba Camps with Julian Pesava originally from the Goldfields Giants, and now signed with Joondalup Wolves.
Brown Park Community Centre
Salisbury Road, Swan View 6056

* Indicates required field

Parent / Guardian's Full Name *

Parent / Guardian's Contact Number *

Parent / Guardian's Email Address *

Please select session: *

Tuesday, 4th January 2022 (11:00-1:00) Monday, 10th January 2022 (1:00-3:00)

Child 1 / Dependant's Full Name *

Child 1 / Dependant's Date of Birth *

Child 2 / Dependant's Full Name *

Child 2 / Dependant's Date of Birth *

Please list any medical issues that may arise in your child/children during session: *

A payment of $50.00 will be required once this registration form has been submitted (EFT details below registration form) to secure your place.

* You understand the risks arising in the course of participating in basketball and basketball related activities, including injury and loss or damage of personal property.
* You acknowledge and consent to image and videos being used for social media (only in our Team Mamba channels). This is to represent highlights of your child/dependent's basketball skills and not to defame in any way.

I acknowledge I have read and understood *

Yes

Submit

EFT Details for the $50.00 fee (unable to accept instant transfers)
TEAM MAMBA PERTH
BSB 303-092
ACCOUNT 0442603

MAMBA Camp with Julian Pesava
REGISTRATION FORM

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MAMBA Camp with Julian Pesava​REGISTRATION FORM

MAMBA Camp with Julian Pesava
REGISTRATION FORM