Shaun Brown's Cricket Coaching

September Holiday Specialist Sessions Booking Form

For extended information on this program, please click here.

Completion of the form below provides you with a TENTATIVE booking only! We will promptly contact you to confirm exact dates and times.

The coaching team look forward to seeing you soon and ensuring that you have an enjoyable, inspiring and rewarding experience.

* Mandatory field

* Title:
* First Name:
* Last Name:
* Age:
* Address:
* City/Suburb:
* State:
* Postcode:
* Phone 1:
   Phone 2:
   Phone 3:
* Email Address:  
  

Dates & Times:


* Choose Preferred Date:
* Choose Preferred Time:

Note: We will contact your to confirm your exact date and time after you have submitted this form.


Additional Purchases:


The following is also available for purchase and will be added to the cost of your camp on checkout:
Cricket Camp Caps + $17.00
Signed Group Photo + $18.00
Mini Bat + $11.00

Other Details


What format would you rather receive your confirmation email in:
TEXT, COLOURS and PICTURES
PLAIN TEXT

Note: The TEXT, COLOURS and PICTURES option is for those users who can receive HTML formatted email. If you often receive emails with text, colours and pictures then choose this option. If not, choose PLAIN TEXT.


* How did you hear about us?:

* SBCC Allergy Policy

None
SLIGHT reaction allergy, please list the allergies and treatment if any.
MILD reaction allergy, you must call the office on 03 9465 6166 before finalising your booking to discuss the management of your child's allergy at the clinic.
SERIOUS reaction which requires an anaphylactic pen injection. Our coaches are not qualified to administer anaphylactic injections. If your child falls into this category they would need to be supervised at all times through the camp. You are also required to call the office on 03 9465 6166 before finalising your booking to discuss the allergy and your child attending our clinic.

* I have read and understand the Allergy Policy. If I chose Mild or Serious from the above policy options, I also confirm I have called your office to discuss this policy.

List special medical conditions that our staff should be aware of, if any:

If you have any comments you would like to leave, please do so below:

Disclaimers:

* I hereby authorise staff to act on my behalf should my child require medical attention, and release Shaun Brown's cricket coaching from any liability for injury incurred by my child at the clinic.

* I understand by completing this form I will be contacted by Shaun Brown's Cricket Coaching.
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