Movement Improvement

Holiday Camps April 2019

Group Bookings

Book as a group of 0 or more people and pay only $65.00 per person.

How many people are there in your group?

Client 1

Client Details

Client First Name

Client Last Name

Date of Birth

Gender

Email Address

Confirm Email Address

Create your password

Enter the password that you would like to use for your new account.

Confirm your password

Home Phone

Mobile/Cell

Parent/Guardian Details

Mother's Name

Mother's Email Address

Mother's Mobile/Cell

Father's Name

Father's Email Address

Father's Mobile/Cell

Address

Address 1

Address 2

Suburb/Town

State/Prov

Zip/Postcode

Health and Fitness

Do you have any injury concerns?

Do you have any medical conditions?

Sport (if applicable)

How did you hear about us?

Dates

From 09-Apr-2019 to 11-Apr-2019

Days & Times

Please select up to 3 sessions.
Once a time slot is full you will be asked to make another choice.

Tuesday, 09-Apr-2019	08:30 AM	to 09:30 AM	ROCKHAMPTON	Day 1 of 3: Speed & Agility Camp - Hegvold Stadium
Wednesday, 10-Apr-2019	08:30 AM	to 09:30 AM	ROCKHAMPTON	Day 2 of 3: Speed & Agility Camp - Hegvold Stadium
Thursday, 11-Apr-2019	08:30 AM	to 09:30 AM	ROCKHAMPTON	Day 3 of 3: Speed & Agility Camp - Hegvold Stadium

DISCLAIMER:
I hereby agree to assume all risks and responsibilities surrounding my (or my child's) participation in the program under the instruction of Movement Improvement 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 Movement Improvement, 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.

Agreement

Signed

Date

/ /

Payment Method

There are no refunds for any enrolments into Movement Improvement related programs. When you sign/tick confirmation for this enrolment you are acknowledging that you know this as a fact and have accepted it as a condition.

Cost

$65.00 Speed & Agility and Strength Camp

Cost Per Person

$65.00

Total Cost

Group Discount

Promo Code

Promo Code Discount

Grand Total

Bank Transfer

Bank details will be provided on the next screen

Please mail this form with a payment attached to: "Movement Improvement Rockhampton, 140 WIlliam Street , Rockhampton QLD 4700"

Photo Approval

At times, Movement Improvement team members or contractors may take photographs or videos of people participating in Movement Improvement provided services for use in marketing/promotional material. Do you allow photographs or videos, for marketing/promotional purposes only, to be taken of yourself/your children?

Yes No