Adult / Age Group Program Information

Size: px
Start display at page:

Download "Adult / Age Group Program Information"

Transcription

1 Adult / Age Group Program Information Welcome to the Sheldon Triathlon Club! The Sheldon Triathlon Club is led by Head Coach, Mr Chris Lang and Club Manager, Mr Jarrod Pleass, with oversight from Sheldon College Director of Sport, Mr David Savage. The Sheldon Triathlon Club (and associated Sheldon College school-based program) is proudly partnered by Triathlon Australia. Please find details of our adult / age group program below Eligibility The adult / age group program is generally open to individuals aged 15 and above who are not current students at Sheldon College. (Separate programs are available to Sheldon College students, including the comprehensive Triathlon Australia endorsed Triathlon Development Academy, the first of its kind in Australia.) Swimming Training All swimming training sessions for adult / age group athletes occurs in the Sheldon College Pool. Athletes require their own kit bag, flippers, pull buoy, kick board, hand paddles and a snorkel. Cycling Training Cycle sessions are available each week for adult / age group athletes. Participants require general cycling equipment including a bike, helmet, spare bag and water bottles. Running Training Adult / age group athletes also have access to running sessions on the main Sheldon College oval. Training Timetable For a copy of the current training timetable, please contact our Head Coach, Chris Lang (c.lang@sheldoncollege.com or ).

2 2014 Fees Participants can select from the following fee options 10 session pass - $130 Unlimited sessions - $150 per month Personalised program $100 per month in addition to any applicable fees above (Chris Lang is happy to explain the additional benefits of personalised programs) Discounts A 10% discount is available for the 3 rd family member and all subsequent family members of our Triathlon Club (does not apply to those on 10 session passes). A 10% discount is also available for paying for 3 months in advance at a time. Such payments are non-refundable. Method of Payment Please complete the attached credit card or direct debit authorisation or contact the Sheldon College Finance Office on to make alternative arrangements. Insurance for Road Rides For insurance purposes, athletes must take out Triathlon Queensland or Cycling Australia membership prior to participating in road rides. Triathlon Queensland Registration / Sheldon Triathlon Club Membership Athletes wishing to compete for the Sheldon Triathlon Club need to register as Sheldon Triathlon Club members with Triathlon Queensland prior to their first race. The online membership process can be found on the Triathlon Queensland website. Other Costs to Consider In addition to training, registration and club membership fees, other costs to consider include personal equipment (swimming, running and cycling gear, including a bike), uniforms (see below) and race entry fees. Uniform Requirements In order to compete for the Sheldon Triathlon Club, participants will at a minimum require the Sheldon Triathlon Club polo shirt and a Sheldon Triathlon Club race suit. Uniform designs, price lists and ordering information can be obtained by contacting our Triathlon Manager, Mr Jarrod Pleass (j.pleass@sheldoncollege.com or ). Competitions/Races Information about upcoming races will be forwarded to all members via . Wet Weather Training will not usually be cancelled due to wet weather. In case of very poor weather or lightning, please call Chris Lang ( ) to confirm whether or not training will be going ahead. Communication General communication will be made via , using the address(es) you supply on the attached form.

3 Duration of Registration Completion of the attached registration form indicates enrolment until such time as you otherwise advise the Sheldon College Finance Office in writing ( One month s notice is required in order to cancel any regular payment plan you have in place. What Now? To register, please complete and return the attached form. (Options for returning this form are noted at the foot of the form.) Questions? If you have any questions not answered above, please contact our Head Coach, Mr Chris Lang (c.lang@sheldoncollege.com or ). Major Sponsor my FootDr The major sponsor of the Sheldon Triathlon Club is the my FootDr chain of podiatry clinics, cofounded by Sheldon College parents, Greg and Sally Dower. Please consider my FootDr for all of your podiatry and footwear needs. Discounts are available for Sheldon Triathlon Club members. Supply Partner Bike Nirvana A supply partnership between the Sheldon Triathlon Club and Bike Nirvana (Victoria Point) has been formed to give our members access to great pricing on bike packages and servicing. For further information, please contact Chris Lang ( or c.lang@sheldoncollege.com).

4 Membership Terms & Conditions In the best interests of all athletes, officials, spectators and the image of our club, the following expectations apply to triathletes and their parents representing our club. Athletes representing our club are required to Give their best effort at all times in training and at race meets Behave in a manner considerate of others and appropriate to a club so closely linked with the reputation of Sheldon College Show the utmost respect for Sheldon College staff, students, facilities and property Respect the decisions of officials and coaches Act as positive ambassadors for our club Parents of athletes representing our club are expected to Keep in mind that children participate for their enjoyment, not for that of their parents Focus upon their child s efforts and self esteem rather than upon race results Encourage their child to be a positive role model Remember that children learn best by example Respect the decisions of officials and coaches and teach their child to do the same Support and encourage their child but leave all specific coaching instructions to the coach Be conscious of the fact that they are representing our club and Sheldon College in the public arena Support their child s commitment to attending training sessions and race meets and contact the coach in advance when this may not be possible Raise any issues they may have with the coach at an appropriate time and in a respectful manner Please note that failure to comply with membership terms and conditions may result in the immediate cancellation of club membership and involvement.

5 ADULT / AGE GROUP REGISTRATION FORM Name: Date of Birth: / / Sex: Male / Female Contact Contact phone numbers: Postal Address: Emergency contact details: Medical information the coach should know: Triathlon Queensland and/or Cycling Australia membership numbers (if known): TQ: CA: Fee choices (please circle applicable fees): 10 session pass ($130) $150 per month $100 per month personalised program Discount (please circle if applicable; not available for 10 session passes): 3 months payment in advance (10%) 3 rd + family member (10%) I hereby agree to enrol in the Sheldon Triathlon Club Age Group program. I agree to comply with the Terms and Conditions outlined on the preceding page. I authorise club staff to arrange medical or hospital treatment for me / my child at my expense, as deemed appropriate at the time. Signed: (parent/guardian if under 18) Please return this form to the Sheldon College Finance Office, it to finance@sheldoncollege.com or fax it to

6 TRIATHLON CLUB CREDIT CARD PAYMENT AUTHORITY I, the authorised Cardholder, (Print Name) authorise Sheldon College Limited to deduct my Sheldon College Triathlon Program payment(s) $ Session Pass / $150 per month unlimited sessions / $100 per month personalised program Monthly programs will be processed on the 18 th of each month (or the next working day) and 10 Session Passes will be processed on the day received via the following credit card: VISA / MASTERCARD (Please circle) CARD NUMBER: / / / EXPIRY DATE:.. /.. I authorise for this agreement to remain in place until such time as it is cancelled by either party in accordance with the Sheldon Triathlon Club Program Information & Registration Form and Conditions outlined below. I authorise for these deductions to be made in line with the Terms and Conditions as outlined below SIGNATURE OF CARDHOLDER: TERMS AND CONDITIONS 1. Sheldon College will charge the cardholder s credit card with the amount authorised above as either a lump sum payment or on a monthly basis on the due date. 2. Should the cardholder wish to stop or defer a credit card payment, notification must be given to Sheldon College in writing at least fourteen (14) days before the next due date. In these circumstances, alternative payment arrangements should be made by the due date in order to avoid the automatic application of the Sheldon College Late Payment Policy. 3. It is the cardholder s responsibility to ensure that there are sufficient funds available on the credit card to allow a credit payment to be made in accordance with this Credit Card Payment Authority. 3.1 In the event of a declined credit card payment, the cardholder will be contacted immediately and an alternative payment method will be required. The Sheldon College Late Payment Policy will automatically apply to any credit card payment that is declined. 4. If it appears that an error has occurred, the cardholder should notify Sheldon College on (07) as soon as possible. This verbal communication must be confirmed in writing with Sheldon College as soon as possible. 5. Sheldon College and its employees will make all reasonable efforts to keep any information in this Credit Card Payment Authority confidential and secure. 5.1 Sheldon College will only disclose information that we have obtained via this Credit Card Payment Authority: (a) to the extent specifically required by law; or (b) for the purpose of this agreement 6. All communication should be directed in writing to The Principal, Attention Director of Business and Commercial Services, Sheldon College, PO Box 1188, CAPALABA QLD 4157.

7 Direct Debit Request Sheldon Triathlon Club Request and Authority to debit the account named below to pay SHELDON COLLEGE Request and Authority to debit Surname or company name Given names or ACN/ABN ( you ) Request and authorise Sheldon College (the User)(User ID number ) to arrange for the amount authorised below to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Request Service Agreement [and any further instructions provided below]. Insert the name and address of financial institution at which account is held Financial institution name Address Insert details of account to be debited Name of account BSB number - Account number Acknowledgment By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit arrangements between you and Sheldon College as set out in this Request and in your Direct Debit Request Service Agreement. $150 per month (unlimited sessions) OR Frequency of Debits $250 per month (unlimited sessions plus personalised program) OR $100 per month personalised program (not including attendance at training sessions) Monthly payments will be processed on the 18 th of each month (or the next working day) Date of first monthly payment / / Signature (If signing for a company, sign and print full name and capacity for signing eg. Director) Address Date / / Please return this form to: Sheldon College P O BOX 1188 CAPALABA DC QLD 4157 Phone (07) Fax (07)

Coaching Enrolment Form

Coaching Enrolment Form Thank you for choosing us. You are a valued member of our tennis centre and we look forward to continuing a long and happy association with you and your family. We offer a wide range of professional coaching,

More information

DIRECT DEBIT REQUEST (DDR)

DIRECT DEBIT REQUEST (DDR) DIRECT DEBIT REQUEST (DDR) This form is your request to pay the total amount of invoices automatically on the due date from your financial account or credit card. You can return this form by: Email: finance@transitcare.com.au

More information

address. Person 1 Person 2 Person 3 Person 4 Person 5

address. Person 1 Person 2 Person 3 Person 4 Person 5 1 Application 1 I wish to Join Medibank Private Transfer from an existing Medibank Private Membership Change my Medibank Private cover Add/delete spouse/partner/dependants Medibank Private (if you have

More information

Your application. X Join X. X Male X Female. X X Mail. SECTION A: I m applying to. SECTION B: Your details. SECTION C: Contact details

Your application. X Join X. X Male X Female. X  X Mail. SECTION A: I m applying to. SECTION B: Your details. SECTION C: Contact details Your application 1. Please complete this form USING BLACK INK and write within the boxes in CAPITAL LTTRS. Mark appropriate answer boxes with a CROSS. Start at the left of each answer space and leave a

More information

Young Adult Membership Application Form

Young Adult Membership Application Form Young Adult Membership Application Form Return completed form to: Navy Health PO Box 172 Box Hill VIC 3128 or email to query@navyhealth.com.au For more information, please call 1300 306 289. Current member

More information

Application for membership of Sydney Zodiacs Inc. 2012/2013. The person named herein, hereby makes application for membership of Sydney Zodiacs Inc.

Application for membership of Sydney Zodiacs Inc. 2012/2013. The person named herein, hereby makes application for membership of Sydney Zodiacs Inc. Application for membership of Sydney Zodiacs Inc. 2012/2013 The person named herein, hereby makes application for membership of Sydney Zodiacs Inc. Please ensure that you read & complete all pages to this

More information

MEMBERSHIP FORM 2019

MEMBERSHIP FORM 2019 MEMBERSHIP FORM 2019 PLEASE COMPLETE ALL DETAILS IN BLOCK CAPITALS & RETURN WITH YOUR SUBSCRIPTION TO: REGISTRATION SECRETARY (Refer to: www.loughreaathleticclub.com) Welcome to Loughrea AC. We are an

More information

GENESIS CHRISTIAN COLLEGE LTD RECURRING BILLING (314011) Direct Debit Request (DDR)

GENESIS CHRISTIAN COLLEGE LTD RECURRING BILLING (314011) Direct Debit Request (DDR) GENESIS CHRISTIAN COLLEGE LTD RECURRING BILLING (314011) Direct Debit Request (DDR) You may contact us as follows: - Phone: 07 3882 9018 Email: finance@genesis.qld.edu.au Mail: P.O. Box 5206 Customer Ref

More information

SCHOOL EASYPAY FEE PAYMENT OPTIONS & PAYMENT METHODS

SCHOOL EASYPAY FEE PAYMENT OPTIONS & PAYMENT METHODS SCHOOL EASYPAY FEE PAYMENT OPTIONS & PAYMENT METHODS After much thought and consideration in regards to the school fees procedure, we are excited to provide you with some information about the mutually

More information

BE A PART OF SOMETHING GREATER Membership Application BRAD AKINS BRANCH

BE A PART OF SOMETHING GREATER Membership Application BRAD AKINS BRANCH BE A PART OF SOMETHING GREATER Membership Application BRAD AKINS BRANCH YMCA Mission: To put Christian principles into practice through programs that build healthy spirit, mind, and body for all. Because

More information

Archdiocese of Wellington Attendance Dues Agreement

Archdiocese of Wellington Attendance Dues Agreement Archdiocese of Wellington Attendance Dues Agreement Between The Roman Catholic Archbishop of the Archdiocese of Wellington, ("the Proprietor") who is the owner of ( the School ) and The Parents/Caregivers

More information

APPLICATION FOR ENROLMENT FORM 2019

APPLICATION FOR ENROLMENT FORM 2019 PO BOX 3440 MIDLAND 6056 WHITEMAN PARK EQUESTRIAN CENTRE GNANGARA RD WHITEMAN PARK Email events@horsemensponyclub.com.au www.horsemensponyclub.com.au APPLICATION FOR ENROLMENT FORM 2019 (All applications

More information

St. Bernadette's Catholic Primary School

St. Bernadette's Catholic Primary School St. Bernadette's Catholic Primary School Grand Ocean Boulevard, Port Kennedy, W.A., 6172 P.O. Box 8151 Warnbro WA 6169 Phone: 9593 4066 Fax: 9593 6596 Email: admin@stbernadettes.wa.edu.au Principal: Mr

More information

Name...Member Number... Team Name... OPERATING SINCE at Trinity College. STARplex. Membership Application Form

Name...Member Number... Team Name... OPERATING SINCE at Trinity College. STARplex. Membership Application Form Name...Member Number... Team Name... OPERATING SINCE 2000 at Trinity College STARplex Membership Application Form STARplex...it s all right here! Membership Application If your membership is for a Fixed

More information

FLORISTRY CAREER CHANGE COURSE ENROLMENT FORM

FLORISTRY CAREER CHANGE COURSE ENROLMENT FORM FIRST NAME: SURNAME: PHONE NUMBER: DATE OF BIRTH: / / EMAIL: POSTAL ADDRESS: SUBURB: STATE: POSTCODE: PLEASE SELECT COURSE LOCATION & DATE: Collingwood, 1 day p/w; Wed May 1- October 16, 2019 Port Melbourne,

More information

TERRYTOWN COUNTRY CLUB

TERRYTOWN COUNTRY CLUB P.O. BOX 1285 1785 CAROL SUE AVE GRETNA, LA 70054 TERRYTOWN, LA 70056 terrytowncountryclub@gmail.com 504-392-7191 2018 RENEWAL LETTER & DUES NOTIFICATION Dear TCC Member(s): It is that time of the year

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM Office use only Policy Number: AN A038364 PAD Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR TRIATHLON AUSTRALIA V-Insurance Group Pty Ltd Level 4, 179 Elizabeth Street, SYDNEY NSW 2000

More information

NHS Nursing Students Placement Costs Bridging Loan

NHS Nursing Students Placement Costs Bridging Loan NHS Nursing Students Placement Costs Bridging Loan 2017-18 Only complete this form if you are: An NHS Nursing Student, on a placement of 4 weeks or more and have no other means of support for the upfront

More information

ENROLMENT FORM. PERSONAL DETAILS Student 1 Name: Date of Birth: / / M / F Student 3 Name: Date of Birth: / /

ENROLMENT FORM. PERSONAL DETAILS Student 1 Name: Date of Birth: / / M / F Student 3 Name: Date of Birth: / / ENROLMENT FORM PERSONAL DETAILS Student 1 Name: Date of Birth: / / M / F Student 2 Name: Date of Birth: / / Student 3 Name: Date of Birth: / / M / F M / F OFFICE USE: Class Email Address: Phone No: Address:

More information

Swim School. 107 Panorama Rd Rooihuiskraal. Fax:

Swim School. 107 Panorama Rd Rooihuiskraal. Fax: 107 Panorama Rd Rooihuiskraal Fax: 086 605 8006 083 264 6187 STUDENT INFO DATE : Date of Birth : Age : Grade : Learn to Swim : 1 2 Private Lessons : Parent and Baby : FOR OFFICE USE ONLY Adult Aqua Aerobics

More information

Membership Registration Form

Membership Registration Form Today s Date: Leeward Judo Club Membership Registration Form Primary Dojo Location (Check box): Pearl City Waipahu Student Information: Name (First, MI, Last) Date of Birth Age Sex Male Female Address

More information

Coronado Islanders Rugby

Coronado Islanders Rugby 2016-17 Registration Packet Checklist Please complete and sign the following forms (check circles as you complete) o Registration o Waiver o Code of Conduct Please provide us with the following information*

More information

Report on Demographic and Consumption Behaviors of USMS Members

Report on Demographic and Consumption Behaviors of USMS Members Report on Demographic and Consumption Behaviors of USMS Members Prepared by Tom Boyd 6/23/2006 The purpose of this report is to reveal demographic and consumption behavior that will help potential sponsors

More information

General Abonnement (GA) order form.

General Abonnement (GA) order form. General Abonnement (GA) order form. When you purchase a GA travelcard, you enter into a contract for an indefinite period. The advantage of this is that your travelcard will automatically be extended once

More information

Distance Learning Enrolment Contract 2017

Distance Learning Enrolment Contract 2017 Student number For office use only Distance Learning Enrolment Contract 2017 Once you have completed the Application Form and paid the R400 non-refundable application fee and your application has been

More information

Savings plans for anyone involved in transport

Savings plans for anyone involved in transport Simple tax-free savings plans Savings plans for anyone involved in transport Saving with the Transport Friendly Society can offer you more Saving for the future is one of those ideas that has always been

More information

GYM MEMBERSHIP APPLICATION

GYM MEMBERSHIP APPLICATION GYM MEMBERSHIP APPLICATION Member Information: Name: Date of Birth: Mobile Phone: Email Address: Postal Address: MEMBERSHIP TYPE: Full Membership: 12 MONTHS $650 6 MONTH $350 Direct Debit Direct Debit

More information

March 1, 2018 HOW TO REGISTER PAYMENT IMPORTANT NOTICES

March 1, 2018 HOW TO REGISTER PAYMENT IMPORTANT NOTICES March 1, 2018 COURSES REGISTRATION HOW TO REGISTER PAYMENT IMPORTANT NOTICES 2018 2018 BRC/ERC/3-Wheel MOTORCYCLE RIDER REGISTRATION FORM Student ID#: Today s Date: Social Security #: Date of Birth: Name:

More information

FEE POLICY: LONG DAY CARE AND OCCASIONAL CARE

FEE POLICY: LONG DAY CARE AND OCCASIONAL CARE FEE POLICY: LONG DAY CARE AND OCCASIONAL CARE INTRODUCTION Goulburn Region Preschool Association (GRPSA) is committed to keeping fees affordable for all families. Fees will be set at an amount that balances:

More information

Loch Nyora Pony Club

Loch Nyora Pony Club Loch Nyora Pony Club Inc A0005690A And Open Show Jumping Competition 6 th January 2019 To be held at the Loch Nyora Pony Club Grounds 27-41 Yannathan Rd / McDonalds Track Nyora 3987 Enquires:- Chris Hill

More information

Parent & Camper Handbook/Manual

Parent & Camper Handbook/Manual SLAM Sports Summer Camp Parent & Camper Handbook/Manual 2014 SLAM 5 5 5 SLAM 326-0003. SLAM SLAM SLAM Charter schools's d SLAM Academy 25.00 9:00 4 120.00 SLAM 5 5 SLAM SLAM SLAM SLAM main lobby of the.

More information

Proudly sponsor: Siena College Summer Sports Camps 2018 Application Form

Proudly sponsor: Siena College Summer Sports Camps 2018 Application Form Proudly sponsor: Siena College Summer Sports Camps 2018 Application Form To be completed by parent or guardian. Please complete all sections. This form may be copied for additional applications. Please

More information

Application Form REINSW Agency/Branch Membership

Application Form REINSW Agency/Branch Membership Application Form REINSW Agency/Branch Membership REINSW APPLICANT INFORMATION CATEGORIES OF MEMBERSHIP AGENCY includes a sole trader, partnership, association, corporation, incorporated or unincorporated

More information

Lakeside Academy Before/After School Care Ridgecrest Rd. Victorville,Ca Phone (760)

Lakeside Academy Before/After School Care Ridgecrest Rd. Victorville,Ca Phone (760) Lakeside Academy Before/After School Care 12303 Ridgecrest Rd. Victorville,Ca Phone (760) 245-8680 www.lakesideacademy.com Lakeside Academy Kids Club 12303 Ridgecrest Rd. Victorville, CA 92395 (760) 245-8680

More information

MEMBERSHIP JOINING FORM

MEMBERSHIP JOINING FORM MEMBERSHIP JOINING FORM DATE: STADIUM 2000 STAFF MEMBER: PERSONAL DETAILS Full Name (First) (Last) Date of Birth Address Email Town Post code Phone (h) (W) (m) Gender: (please circle one) MALE / FEMALE

More information

Title: Mr / Mrs / Ms / Miss. First Name: Surname: GENDER: M/F D.O.B.: / / AGE: years

Title: Mr / Mrs / Ms / Miss. First Name: Surname: GENDER: M/F D.O.B.: / / AGE: years MEMBERSHIP FORM New Member- Renewing Member 1. MEMBER DETAILS Title: Mr / Mrs / Ms / Miss Date: / / First Name: Surname: GENDER: M/F D.O.B.: / / AGE: years Address: Suburb: Post Code: Phone: (H) (Mob)

More information

SECTION 1: Choose your plan

SECTION 1: Choose your plan AveoConnect Pty Ltd Level 1, 76 Skyring Terrace Newstead QLD 4006 sales@aveoconnect.com.au 1300 851 496 Application for a Bundle, Home Phone or Home Broadband Office Use Only Sales Person: Promotion Code:

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM Willis Australia Limited ABN 90 000 321 237 AFS 240600 Office use only Policy Number: SUA/003700 Claim Number:. PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR NETBALL QUEENSLAND Willis Australia Limited

More information

Application for registration of a Limited Partnership Limited Partnerships Act 2008

Application for registration of a Limited Partnership Limited Partnerships Act 2008 Page 1 of 9 Version October 2017 www.limitedpartnerships.govt.nz 0508 266 726 Post your completed form to: National Processing Centre, Private Bag 92061, Victoria Street West, Auckland 1142 Application

More information

Run of Our Range Full Membership Plan This Membership Plan Requires a 12 Month Contract Paid Monthly or Prepaid in Full

Run of Our Range Full Membership Plan This Membership Plan Requires a 12 Month Contract Paid Monthly or Prepaid in Full Run of Our Range Full Membership Plan This Membership Plan Requires a 12 Month Contract Paid Monthly or Prepaid in Full Full Membership Contract Requirements This membership plan requires a minimum twelve

More information

Summer Adult Strength & Conditioning

Summer Adult Strength & Conditioning Create Your Opportunity Summer Adult Strength & Conditioning - 2019 [ Monday April 29th, 2019 - Saturday November 2nd, 2019 ] Name: Home Phone Athlete Cell: E-mail: Address: City: Country: Prov: Postal:

More information

Southend United 2018/19 Season Cards...

Southend United 2018/19 Season Cards... Southend United 2018/19 Season Cards... WELCOME... I ve been overwhelmed by the amount of goodwill that s been shown to me since becoming Manager of Southend United Football Club. There s certainly been

More information

Change of details form

Change of details form Change of details form AT YOUR FINANCIAL SERVICE Issued 30 June 2008 Suncorp Portfolio Asteron Services Portfolio Limited Services ABN Limited 61 063 ABN 427 61958 063 (Trustee) 427 958 AFS Licence No

More information

PHENOM ATHLETES PROFILE SHEET SECTION ONE. Personal Information. Physical Information. Athlete s History. Goals. Client Name: Address:

PHENOM ATHLETES PROFILE SHEET SECTION ONE. Personal Information. Physical Information. Athlete s History. Goals. Client Name: Address: PHENOM ATHLETES PROFILE SHEET SECTION ONE Personal Information Client Name: City: State: Zip: Date of Birth: Age: Place of Birth: School: Grade: Physical Information Height: Weight: Shoe: Shirt: Pants:

More information

MEMBERSHIP AGREEMENT

MEMBERSHIP AGREEMENT MEMBERSHIP AGREEMENT This MEMBERSHIP AGREEMENT (the Agreement ) is made this day of, 2016, by and between Premier Pediatric Concierge Care, PC ( Premier ) and the undersigned parent ( Parent ), on behalf

More information

CAPITAL BADMINTON ACADEMY.

CAPITAL BADMINTON ACADEMY. CAPITAL BADMINTON ACADEMY www.capitalbadmintonacademy.com ABOUT US Welcome to Capital Badminton Academy! We re a badminton academy based in DMV (DC, Maryland and Virginia) and we train domestic and regional

More information

INSTRUCTIONS FOR COMPLETING THIS UCI LICENCE APPLICATION PRIORITY PROCESSING FEES MTBA / BMXA MEMBERS CHECKLIST

INSTRUCTIONS FOR COMPLETING THIS UCI LICENCE APPLICATION PRIORITY PROCESSING FEES MTBA / BMXA MEMBERS CHECKLIST INSTRUCTIONS FOR COMPLETING THIS UCI LICENCE APPLICATION A UCI licence confirms that the holder undertakes to respect the constitution and regulations of the Union Cycliste Internationale. A UCI licence

More information

2017 TWILIGHT ENROLMENT DAY and DATES

2017 TWILIGHT ENROLMENT DAY and DATES 2017 TWILIGHT ENROLMENT DAY and DATES Please join us as we kick off the new Pony Club year with this FREE event. Children of all ages are more than welcome to attend so please come along and meet our members,

More information

ambulance cover from under 63 p a week

ambulance cover from under 63 p a week 2018 ambulance cover from under 6 p a week What does it cost? SINGLE membership of.00 provides cover for a single person only. CHILD membership of 12.00 provides cover for one child up until the end of

More information

FLYERS AFTER SCHOOL PROGRAM APPLICATION FOR CHILD. Childs Information. Date of Application: Child s Name (first & last name)

FLYERS AFTER SCHOOL PROGRAM APPLICATION FOR CHILD. Childs Information. Date of Application: Child s Name (first & last name) FLYERS AFTER SCHOOL PROGRAM 2014-2015 APPLICATION FOR CHILD *All information must be complete in order to enroll Childs Information Child s Name (first & last name) Name of School and Grade Date of Birth

More information

Motorcycling Australia Northern Territory PO BOX Casuarina NT

Motorcycling Australia Northern Territory PO BOX Casuarina NT Accreditation and Licensing Requirements There are three main aspects to being recognised as a Level 1 coach under s National Coaching Accreditation Scheme, they are: - 1. Obtaining a Level 1 Motorcycle

More information

Benefit payment Division C Complete this form using BLACK INK and print well within the boxes in CAPITAL LETTERS. Mark appropriate answer boxes with a cross like the following X. Start at the left of each

More information

Requirements for New Cats Club Enrollment

Requirements for New Cats Club Enrollment Requirements for New Cats Club Enrollment Registration Form Charge Requirement Form Auto Debit Form with voided check Parent Handbook Receipt KY Immunization Certificate with Hepatitis A immunization (per

More information

Membership Application Form

Membership Application Form Membership Application Form Silver Willow in this document means Silver Willow Pheasant Farm LTD. Don Day, Gwen Day and Josh Day NOTES FOR APPLICANTS Please read this form carefully especially the declaration

More information

1. Personal Details and Academic History Compulsory

1. Personal Details and Academic History Compulsory Registration form for CAIA Programs PLEASE NOTE: CATEGORY 1 TO 4 MUST BE COMPLETED BY ALL STUDENTS. 1. Personal Details and Academic History Compulsory Mr Mrs Miss Ms Other Initials Surname First Name/s

More information

County: State: ZIP: Address: Billing Address for Premium Notices (complete only if different from above).

County: State: ZIP:  Address: Billing Address for Premium Notices (complete only if different from above). Application Form Complete and sign the application. A-425 P.O. Box 6170, Columbia, SC 29260-6170 Blue Option benefits are provided in network only. No benefits are provided for services received out of

More information

Recreational Dance & Acrobatic Class Policies

Recreational Dance & Acrobatic Class Policies 2016-2017 Recreational Dance & Acrobatic Class Policies Welcome to EXPRESS Dance & Acrobatics. Our mission is to teach the fundamentals of dance and acrobatics, with an emphasis on commitment, education,

More information

Application for Youthsaver Account Section A Details of the applicant aged under 18

Application for Youthsaver Account Section A Details of the applicant aged under 18 Application for Youthsaver Account Section A Details of the applicant aged under 18 1 Title Full given name/s Surname Other names known by (if any) Gender of birth Occupation Male Female 2 Residential

More information

Your super application and change form

Your super application and change form United Technologies Corporation Retirement Plan Your super application and change form Accumulation members UTC gives you a number of options for your super. Use this form to: < Join the Plan if you are

More information

additional $785 additional $390 additional $195

additional $785 additional $390 additional $195 ADDITIONAL PRIVILEGES Also available to our Members are facility rentals, access to most JCCs nationwide, member-only publications, priority registration, membership discount on programs and so much more!

More information

OPEN DRESSAGE JACKPOT

OPEN DRESSAGE JACKPOT OPEN DRESSAGE JACKPOT SATURDAY 16 th APRIL, 2016 PONY CLUB VICTORIA EQUESTRIAN CENTRE 640 Yarra Junction Noojee Rd, Gladysdale Vic 3797 *Open to all RIDERS Entries CLOSE: 6 th April, 2016 Proudly Sponsored

More information

RIVERSIDE ACADEMY TUITION & FEE SCHEDULE Tuition Rates

RIVERSIDE ACADEMY TUITION & FEE SCHEDULE Tuition Rates RIVERSIDE ACADEMY 2017-2018 TUITION & FEE SCHEDULE Tuition Rates FAMILY TUITION DISCOUNTS (Deducted from total) Children Discount High School (9 th -12 th ) $6,248.00 2 13% Middle School (6 th -8 th )

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM Office use only Policy Number: Claim Number:. PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR BASKETBALL QUEENSLAND V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised representative

More information

Studio Policies

Studio Policies 2018-19 Studio Policies Welcome to EXPRESS Dance & Acrobatics. Our mission is to teach the fundamentals of dance and acrobatics, with an emphasis on commitment, education, safety, and fun in a healthy

More information

BASKETBALL NEW SOUTH WALES

BASKETBALL NEW SOUTH WALES Office use only Policy Number: Claim Number: BASKETBALL NEW SOUTH WALES PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR BASKETBALL NSW V-Insurance Group Pty Ltd Authorised Representative No. 432898 Of

More information

Option 1 - Upfront payment

Option 1 - Upfront payment 20 November 2015 Dear Parents and Guardians For the past three years the College Council has undertaken an in-depth review of the College budget and its financial arrangements. This review identified a

More information

DCU Summer Scholars Application Form 2019

DCU Summer Scholars Application Form 2019 DCU Summer Scholars Application Form 2019 PLEASE TYPE OR PRINT LEGIBLY IN INK. BE SURE TO COMPLETE ALL INFORMATION Student Information CTYI Student No. (as per mailing envelope) Full Name Last Name First

More information

Blue Shield of California Blue Shield of California Life & Health Insurance Company Dental plan, vision plan, and dental + vision package application

Blue Shield of California Blue Shield of California Life & Health Insurance Company Dental plan, vision plan, and dental + vision package application Blue Shield of California Blue Shield of California Life & Health Insurance Company Dental plan, vision plan, and dental + vision package application This form is to be used by applicants applying for

More information

The Works Fit & Well Membership Form. I give permission for USQ staff to send correspondence to me via /sms.

The Works Fit & Well Membership Form. I give permission for USQ staff to send correspondence to me via  /sms. The Works Fit & Well Membership Form Clive Berghofer Recreation Centre Personal Details Please print your full legal name Family Name Given Name/s Date of Birth / / Gender Email Address Postal Address

More information

ANZ KIWISAVER SCHEME PRODUCT DISCLOSURE STATEMENT

ANZ KIWISAVER SCHEME PRODUCT DISCLOSURE STATEMENT ANZ KIWISAVER SCHEME PRODUCT DISCLOSURE STATEMENT 24 NOVEMBER 2017 ISSUER AND MANAGER: ANZ NEW ZEALAND INVESTMENTS LIMITED This product disclosure statement replaces the product disclosure statement dated

More information

APPLICATION FOR AFFILIATION

APPLICATION FOR AFFILIATION APPLICATION FOR AFFILIATION MEMBERSHIP YEAR 01/07/2018 EXPIRES 30/06/2019 Agricultural / Show Society Club Affiliate Sport Affiliate/Schools Commercial Group Affiliate Details (PLEASE PRINT IN BLOCK LETTERS)

More information

Bus Association Victoria. Full Name in Which Membership is required:

Bus Association Victoria. Full Name in Which Membership is required: Membership Application Form 2018/2019 Bus Association Victoria Full Name in Which Membership is required: ABN: (Insert Company Name, Individual or Partnership details listed on TSV Accreditation) Trading

More information

*AHSEP reserves the right, at its sole discretion, to reject any candidate who does not meet the eligibility requirements as stated herein.

*AHSEP reserves the right, at its sole discretion, to reject any candidate who does not meet the eligibility requirements as stated herein. AHSEP Enrollment Information Hobie Wave 14 Sailing Classes Youth: Thursdays July 27 & August 3 5:30 8:30 Adults: Saturdays July 29 & August 12 1:30-4:30 The 2017 Hobie Wave 14 Sailing Classes will be a

More information

Sydney FC Membership Terms and Conditions

Sydney FC Membership Terms and Conditions Sydney FC Membership Terms and Conditions 1. General 1.1 Membership Definition & Rights Sydney FC offers Membership in the form of ticketed and non-ticketed packages which are renewed on a yearly basis.

More information

Dear Team Captains, Managers and Members The waiver consists of : 1. Team Waiver which also acts as the team roster. 2. Combined Team waiver signature page for: Apendix A, B, B1, C 3. Appendix A: Team:

More information

Wattle Flat Recreational Reserve Castlemaine

Wattle Flat Recreational Reserve Castlemaine COMBINED TRAINING AND DRESSAGE JACKPOT COMBINED TRAINING AND DRESSAGE JACKPOT Wattle Flat Recreational Reserve Castlemaine 22nd of November 2015 Proudly Sponsored by CASTLEMAINE BENDIGO BENDIGO Pony Club

More information

Application for Accreditation by Testing

Application for Accreditation by Testing Application for Accreditation by Testing A FORM Please use a blue or black pen to complete this form. Please print in BLOCK LETTERS. NAATI Number: (if known) Part 1 Is this your first application to NAATI?

More information

Horsham City Rowing Club Inc.

Horsham City Rowing Club Inc. Horsham City Rowing Club Inc. PO BOX 200 Horsham VIC 3402 1 Barnes Boulevard Horsham VIC 3400 APPLICATION FOR MEMBERSHIP 2017-2018 SEASON DETAILS OF APPLICANT Full Name Address BH Telephone AH Telephone

More information

SPORTING ACCIDENT CLAIM FORM Eastern Football League

SPORTING ACCIDENT CLAIM FORM Eastern Football League Dear Member, SPORTING ACCIDENT CLAIM FORM Eastern Football League Please read this page first before completing the Claim Form Sportscover Australia Pty Ltd Thank you for your Claim Form request. This

More information

Flinders University AUS Participant Agreement Form 2017

Flinders University AUS Participant Agreement Form 2017 Flinders University AUS Participant Agreement Form 2017 This agreement is completed in addition to the Australian University Sport event participation agreement. Please read it carefully and sign as appropriate

More information

SMSF ADMINISTRATION SERVICE AGREEMENT

SMSF ADMINISTRATION SERVICE AGREEMENT SMSF ADMINISTRATION SERVICE AGREEMENT About our SMSF Service Establishing and operating a self-managed super fund (SMSF) is an exciting and positive step in your lifelong financial journey. SMSFs however

More information

YMCA AFTER SCHOOL CARE REGISTRATION PACKET

YMCA AFTER SCHOOL CARE REGISTRATION PACKET YMCA AFTER SCHOOL CARE REGISTRATION PACKET 2016-2017 Welcome! We look forward to having your family join us in the YMCA After Care Program! Sarah Kim Child Care Director 734.661.8058 skim@annarborymca.org

More information

Blue Knob Snow Sports Club, Inc Registration Form 2018/2019 Ski Season

Blue Knob Snow Sports Club, Inc Registration Form 2018/2019 Ski Season Registration Information: 1. All participants should be at least 8 years of age (Category U10) by Dec 31 st 2018. 2. Intermediate skiing skills are necessary (parallel turns on most slopes). 3. Participants

More information

Application for Membership

Application for Membership AMERICAN ACUPUNCTURE COUNCIL Application for Membership Contact and Practice Information: Full Name (First, Middle, Last) Practice / Clinic Name Office Address (include Suite #) City State Zip Mailing

More information

ONEANSWER KIWISAVER SCHEME PRODUCT DISCLOSURE STATEMENT

ONEANSWER KIWISAVER SCHEME PRODUCT DISCLOSURE STATEMENT ONEANSWER ONEANSWER KIWISAVER SCHEME PRODUCT DISCLOSURE STATEMENT 10 AUGUST 2018 ISSUER AND MANAGER: ANZ NEW ZEALAND INVESTMENTS LIMITED This product disclosure statement replaces the product disclosure

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM V-INSURANCE GROUP Corporate Authorised Representative of Willis Office use only Policy Number: 01PO527349 Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR LITTLE ATHLETICS AUSTRALIA V-Insurance

More information

GoodNeighborInsurance. 690E.WarnerRd.Suite117 Gilbert,AZ85296,USA

GoodNeighborInsurance. 690E.WarnerRd.Suite117 Gilbert,AZ85296,USA GoodNeighborInsurance AFTERFILLING OUTTHISAPPLICATION PLEASEMAIL,FAX,OREMAILSCANTO: GoodNeighborInsurance 690E.WarnerRd.Suite117 Gilbert,AZ85296,USA TolFree:866-636-9100 Phone:480-633-9500 Fax:480-813-9930

More information

WELCOME TO STANLY COUNTY GYMNASTICS!

WELCOME TO STANLY COUNTY GYMNASTICS! WELCOME TO STANLY COUNTY GYMNASTICS! 1960 Post Rd. Albemarle, NC 28001 Phone: 704-983-2414 Email: stanlycountygymnastics@gmail.com Website: www.stanlycountygymnastics.wildapricot.org Stanly County Gymnastics,

More information

GLOBAL EDUCATION CENTER. GLOBAL EXPEDITION CONTRACT ( - Summer ) APPLICANT INFORMATION. Male Female Yes No DATE OF BIRTH GENDER HIGH SCHOOL STUDENT?

GLOBAL EDUCATION CENTER. GLOBAL EXPEDITION CONTRACT ( - Summer ) APPLICANT INFORMATION. Male Female Yes No DATE OF BIRTH GENDER HIGH SCHOOL STUDENT? GLOBAL EDUCATION CENTER GLOBAL EXPEDITION CONTRACT ( - Summer ) APPLICANT INFORMATION NAME AS IT APPEARS ON YOUR PASSPORT (Last, First, Middle Initial) STUDENT ID NO. ADDRESS (Number, Street, Apartment)

More information

Opt out of the Teachers Pension Scheme.

Opt out of the Teachers Pension Scheme. Opt out of the Teachers Pension Scheme. Part. A: To be completed by the applicant in all cases. tes: This form should be completed if your employer enrolled you in the Teachers Pension Scheme (TPS) but

More information

Walter F. Ehrnfelt Recreation Center Royalton Road, Strongsville, Ohio

Walter F. Ehrnfelt Recreation Center Royalton Road, Strongsville, Ohio Annual Membership Packages for the Walter F. Ehrnfelt Recreation Center 18100 Royalton Road, Strongsville, Ohio 44136 440.580.3260 www.strongsville.org Fees effective as of October 1, 2014 You now have

More information

Payment of School Fees by Direct Debit Option

Payment of School Fees by Direct Debit Option Payment of School Fees by Direct Debit Option The Monte Sant Angelo Mercy College (MSAMC) Direct Debit Instalment Plan for paying school fees and charges enables parents/carers to spread the payment of

More information

DCU. Summer Scholars 2018 Summer Programme (2-week) Application Form. For Secondary School Students (12-17 years) Application Deadlines

DCU. Summer Scholars 2018 Summer Programme (2-week) Application Form. For Secondary School Students (12-17 years) Application Deadlines DCU Summer Scholars 2018 Summer Programme (2-week) Application Form For Secondary School Students (12-17 years) Application Deadlines Early Application Deadline Friday, 26 th January 2018 Financial Aid

More information

SNOW TRIPPIN This is a competitively priced tour which will provide between students a week of a wonderful ski experience.

SNOW TRIPPIN This is a competitively priced tour which will provide between students a week of a wonderful ski experience. SNOW TRIPPIN 2013 23 November 2012 Dear Students / Parents / Guardians This is the first notice to parents of students interested in attending the 2013 Ski Trip. The trip is open to years 10-12. The tour

More information

Patient Information. Patient Name: Address . City State Zip. Birthdate Sex: Female Male Marital Status: Married Single Other

Patient Information. Patient Name: Address  . City State Zip. Birthdate Sex: Female Male Marital Status: Married Single Other Patient Information Patient Name: Address Email City State Zip Birthdate Sex: Female Male Marital Status: Married Single Other Home Phone Work Phone Cell Phone Student Status: Full Time Part Time None

More information

Functional Athletics Membership Agreement. Registration; Training Session Purchase Agreement; Terms and Conditions

Functional Athletics Membership Agreement. Registration; Training Session Purchase Agreement; Terms and Conditions Functional Athletics Membership Agreement Registration; Training Session Purchase Agreement; Terms and Conditions Welcome to Functional Athletics Inc ( Trainer ) and congratulations on beginning your fitness

More information

PERSONAL ACCIDENT CLAIM FORM

PERSONAL ACCIDENT CLAIM FORM PERSONAL ACCIDENT CLAIM FORM Office Use Only Claim number Reference Complete this form if You have suffered an accident, outside working hours and wish to claim weekly, capital and/or broken bones benefits

More information

FINANCIAL SERVICES GUIDE

FINANCIAL SERVICES GUIDE FINANCIAL SERVICES GUIDE The financial services referred to in this guide are offered by the APS Benefits Group Ltd. Address: 440 William Street, West Melbourne Victoria 3003 (PO Box 326, North Melbourne

More information

El Rincon (310)

El Rincon (310) 2015 2016 El Rincon (310) 736-8575 Welcome to STAR, STAR, Inc. is a charitable 501(c)(3) non-profit education organization serving kids, families, schools, and communities. For your convenience, the Galaxy

More information

Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church

Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church th Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church Session II: June 12th - June 16th, Performance June 13th; Music On Wheels Academy Music Camp

More information