Child Name

Child Date of Birth

Child Gender
MaleFemale

Any medical conditions or allergies?
YesNo

Please provide details (if yes):

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone

Program of Interest
School Holiday Sport Program (Wollongong)School Holiday Sport Program (Eurobodalla)School Holiday Football Clinic (Wollongong)

Day(s) of Attendance
TuesdayWednesdayThursdayFridayFull Week

Week(s) of Attendance
Week 1Week 2Both Weeks