SURNAME: ________________________________________ FIRST NAME: __________________________

Parent name/s: _________________________________________________________________________

ADDRESS: ______________________________________________________________________________

PHONE: (Home): __________________ (Business): __________________ Mobile: __________________

NAME OF SCHOOL (If student):_____________________________________________________________

EMERGENCY CONTACT: _________________________________________Phone No. ________________

EMAIL ADDRESS: _________________________________________________________________________

DATE  OF  BIRTH ________________________________         Current Age is _____________________

DAYS:          [_] MONDAY 3:30PM~4:15PM(Beg)                    [_]   MONDAY  4:15PM~5:00PM (Beg)

                 [_]    SATURDAY  9:15AM~ 10:00AM (Beg/Inter)   [_] SATURDAY Kids Club 10:00AM ~10:30AM  (5yr~7yr)

                  [_] FRIDAY 3:30PM~4:15PM(Beg/Inter)              [_] FRIDAY 4:15PM~5:00PM (Beg/Inter) 

                  [_] FRIDAY 5:00PM~5:45PM (Inter/Adv)             [_] FRIDAY 5:45PM~6:15PM (Adv)

                  [_] WEDNESDAY   3:30PM~4:15PM(Beg)             [_] WEDNESDAY 4:15PM~4:45PM (Beg/Inter)   

                  [_]     WEDNESDAY  5:15PM~6:00PM (Adv 11yr~18yrs)

TIMES –   Private lessons will be available before and after classes by appointment. Please contact Chris for your preferred Day and Time

TIME:  Please indicate your preferred coaching day and time: __________________________________________

_______________________________________________________________________________________

2^ND PREFERENCE: ________________________________________________________________________

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 PLEASE  RETURN THIS FORM TO CHRIS TREGONNING EITHER VIA EMAIL (christreg@netspace.net.au) or P.O BOX 489 , BERWICK 3806