APPLICATION FORM

Coaching Camp For Young Cricketers

  

September 2010 CAMP DATES

1.  Intermediate Camp for 10--14 yr olds  

     19th  - 21st  Sept    $350

2.  Advanced Camp for 14 --17 yr olds

    26th - 28th  Sept     $350

Price includes 2 and a half days with top qualified accredited coaching, optional DVD, plus on-site accommodation, net practice and turf wicket matches. All meals are supplied.

 Optional  but recommended DVD $25.

 

To secure your spot, please print out and complete the form below and return with a deposit of $80 or the total by cheque or credit card  to Hume and Hovell Cricket Ground, 7 Hanna’s Rd, Strath Creek, Vic, 3658. The balance to be paid prior to the commencement of the camp. We look forward to seeing you! Optional but recommended DVD $25.
$350

Camp Type: (circle)

Intermediate   or   Advanced

 

    

Surname

 ___________________

Given names

 ___________________

Address

 __________________________P/Code______________________Post

Telephone Home

 ___________________

Work

 ___________________

Email

 ___________________

DOB

 ___________________

Credit Card No

 ___________________

Expiry

 ___________________

Credit Card Type:
Visa Mastercard Amex Other

 ___________________    

T-Shirt Size (circle) – Men's S  M  L  XL  XXL

                              Boy's 8  10  12  14  

Playing Experience

School

 ___________________    

Club

 ___________________    

District

 ___________________    

Batsman (circle)
Left hand
Right Hand
Top order
Middle order
Lower order
Wicket keeper
Bowler (circle)
Right arm
Left arm
Fast
Medium
Offspin
Legspin

Special medical conditions our staff should be aware of:
_________________________________________________________________________________________

I authorise the Camp Co-Ordinator, Head Coaches or their delegates to arrange medical treatment as required during the camp. Parents Guardians will be notified accordingly.
Signed
 ___________________
Parent/Guardian
 ___________________

Parents Christian and Surnames______________________________________________________________