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Holiday Clinics
Next Holiday Clinic Dates
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FAQ
Book Now
Sponsors
About Us
Info about our staff
Info about Alleygators
Contact
Home
Book Now
Privacy Policy
Terms of Participation
Holiday Clinics
Next Holiday Clinic Dates
Holiday Clinic Packs
FAQ
Book Now
Sponsors
About Us
Info about our staff
Info about Alleygators
Contact
Book Now
Parent / Carer Details
Name
*
First
Last
Parent / Carers Contact Number
*
Parent / Carers Email
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
No of Children attending
1
2
3
4
Player 1 Details
Is your child a returning player?
*
Yes
No
Holiday Clinic Date
-- select --
Monday 3rd July: U6 – U10
Tuesday 4th July: U11 – U14
Wednesday 5th July: Girls only
Wednesday 5th July: U18’s Boys
Name
*
First
Last
DOB
*
Gender
*
Male
Female
Name of Junior Rugby Club your child plays for
What School does your child attend?
Does your child have any illnesses, allergies or injuries we should know about? Please provide details...
*
Player 2 Details
Is your child a returning player?
*
Yes
No
Holiday Clinic Date
-- select --
Monday 3rd July: U6 – U10
Tuesday 4th July: U11 – U14
Wednesday 5th July: Girls only
Wednesday 5th July: U18’s Boys
Name
*
First
Last
DOB
*
Gender
*
Male
Female
Name of Junior Rugby Club your child plays for
What School does your child attend?
Does your child have any illnesses, allergies or injuries we should know about? Please provide details...
*
Player 3 Details
Is your child a returning player?
*
Yes
No
Holiday Clinic Date
-- select --
Monday 3rd July: U6 – U10
Tuesday 4th July: U11 – U14
Wednesday 5th July: Girls only
Wednesday 5th July: U18’s Boys
Name
*
First
Last
DOB
*
Gender
*
Male
Female
Name of Junior Rugby Club your child plays for
What School does your child attend?
Does your child have any illnesses, allergies or injuries we should know about? Please provide details...
*
Player 4 Details
Is your child a returning player?
*
Yes
No
Holiday Clinic Date
-- select --
Monday 3rd July: U6 – U10
Tuesday 4th July: U11 – U14
Wednesday 5th July: Girls only
Wednesday 5th July: U18’s Boys
Name
*
First
Last
DOB
*
Gender
*
Male
Female
Name of Junior Rugby Club your child plays for
What School does your child attend?
Does your child have any illnesses, allergies or injuries we should know about? Please provide details...
*
In an emergency, do you authorise the Southern Cross Rugby to arrange any necessary medical treatment for your child/ren where contact with yourself or nominated contact are unavailable?
*
Yes
No
How did you hear about Southern Cross Rugby?
*
Yes, I agree to Terms and Conditions
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