Welcome to Australian Basketball Services www.ausbasketball.com.au

Specialist Skill Clinic Registration

* Indicates required field

Enquiy Form

*Name:

School Attended:

Age :

Parent / Guardian Name:

Address:

*Email Address:

*Mobile Phone:

Phone:
( )
Medical Condition or allergy that our coaches need to know about:

I would like to attend:

PAYMENT DETAILS - Make cheques payable to Australian Basketball Services Pty Ltd.
Please contact me for payment details
A cheque will be posted to Australia Basketball Services

Condition to be acknowledged by parent / guardian.

"I give permission for my son / daughter to attend the Basketball clinic. I understand that the clinic organisers will make every effort to ensure the safety of my child. I will not hold them responsible for any injuries that occur during the clinic. Any photographs or images taken at the clinic may also be used by the organisers for future promotional use."

Other Enquiries or Feedback:

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AND1 3 On 3

Hills

AND 1 Camp Penrith

HEAD OFFICE (Melbourne Australia)

P.O. Box 4116 Balwyn East Vic 3103 Ph: 613 9415 6112 Fx: 613 9415 6119