Brisbane Basketball Incorporated

Player/Athlete 1

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Player/Athlete Details

Player/Athlete First Name

Player/Athlete Last Name

Date of Birth

Gender

Male Female

Email Address

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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)

Dates

Days & Times

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

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

Payment Method

There are no refunds for any enrolments into Brisbane Basketball Incorporated 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.

				Mon	Wed	Fri
8:00 am	January 4th, 6th & 8th	Option #1 - Court #3, NAB Stadium	$25
9:00 am	January 4th, 6th & 8th	Option #2 - Court #3, NAB Stadium	$25
10:00 am	January 4th, 6th & 8th	Option #3 - Court #3, NAB Stadium	$25

Brisbane Capitals - January 2016 (Week #1) Technical Shooting Sessions: with Coach Andy Sobieszuk (International Skills & Performance Coach)