U12 Registration

Commencing: Sunday 14th August 2016 to 28th August - 5 WEEKS

2.30 - 4.00pm Albany Creek Leisure Centre, Explorer Drive, Albany Creek.

Boys & Girls born 2002 and younger. Experienced coaches will provide a skills session each week followed by game play.

Cost is $70 per player, including registration and insurance, and pool entry for players and spectators.

REGISTRATION FORM

Player Name

Date of Birth

Gender

Male Female

Have you played Flippa Ball or Water Polo before?

Yes No

If so where?

Email Address

Emergency contact mobile no

Emergency contact name

PLEASE NOTE: Payment MUST BE MADE with registration to ensure confirmation. Also, please note there are no part payments or refunds for sessions not attended.

NORTH BRISBANE WATER POLO CLUB INC.
BSB: 124-001
ACCOUNT: 10401503
Reference: (SURNAME)U12

If you do not have access to internet banking, you can make a deposit at any Bank of Queensland branch using the above deposit details. Thank you.

I confirm that I have made payment for this player via direct bank deposit

Any queries, please contact Jane at u12@polobears.com.au

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