Rams Summer Clinic 2001 Registration Form

2001 CLINIC REGISTRATION FORM

Please print this form (2 pages) and send with any cheque payment to: .
Canterbury Rams Basketball
PO Box 31172
CHRISTCHURCH

NOTE: Please ensure that parent/caregiver has read conditions
and signed the declaration on page 2.

Name	__________________________________________________
Sex	M	F	Date of Birth __________________
Address	__________________________________________________
Suburb	__________________________________________________
City	__________________________________________________
e-mail	__________________________________________________
Health	- conditions, allergies, asthma, medication (confidential)
	__________________________________________________
	__________________________________________________
Parent / Caregiver contact during Clinic:
Name	__________________________________________________
Phone	(H) ________________
	(W)________________

Child T-shirt (please circle one size):
Children's Sizes	S	M	L	XL
Adult's Sizes	S	M	L
(T-shirts will be distributed ar the Clinic)

Payment Method:	O Visa	O Mastercard
($125 per person)	O Cheque (enclose cheque payable to Canterbury Rams).
Credit Card #	___________________________
Expiry Date	___________________________
Signature	___________________________
Print name as it appears on card	___________________________ - Continued on next page

Conditions:

All registrations are subject to approval from clinic management
Behaviour: Parents will be contacted if a child's behaviour warrants. Clinic Management has the right to withdraw access without refund should a child's behaviour be unmanageable.
Supervision: Staff will supervise between 9am-3pm daily only.
Payment & Refund: Full payment required with registration. Refunds will only be given in extunating circumstances at the discreation of Clinic Management.

Parent/Caregiver Declaration:

I approve of the above basketball clinic application and conditions. I understand that the clinic staff and Pioneer Stadium emplyees will exercise due care, but accidents may happen. I authorise any medical care urgently required. I understand that my child will be held responsible for his/her behaviour.

Signed:	_____________________________ Parent / Caregiver
Date:	_____________________________

Further informaton will be sent once registration has been received.