Course Registration Form

Sharks Summer Camp 2019

Please fill out the form carefully for registration. * A $10.00 one-off registration fee is payable on signing up.
Player Name

First Name Middle Name Last Name
Birth Date

Month Day Year

Parent/Guardian Address

Street Address
Street Address Line 2
City	State
Postal Code	Country

E-mail
Mobile Number

Area Code Phone Number
Are you a 2019 Sharks registered player?
If not, have you played rugby league before?
Does your child have an allergy or any medical issue we need to be aware of?

Pay $10.00 Registration for the program here

product

Summer Camp $ 10.00 AUD

Quantity

Total $ 0.00 AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

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