Missfits - Sports Camp Registration 2017
Personal Details
Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
Year
Shirt Size
*
Please Select
S
M
L
XL
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church (If Applicable)
Cellphone Number
-
Area Code
Phone Number
Contact E-mail
*
Been before?
Yes
No
Preferred Sports
Sport #1
*
Please Select
Archery
Athletics
Basketball
Bowls
Croquet
Cross Country
Darts
Hockey
Hole in 1 golf
Indoor Hockey
Indoor Soccer
Netball
Petanque
Rugby
Shooting
Soccer
Softball
Table Tennis
Tag/Rippa Rugby
Touch Rugby
Volleyball
Wallball
Sport #2
*
Please Select
Archery
Athletics
Basketball
Bowls
Croquet
Cross Country
Darts
Hockey
Hole in 1 golf
Indoor Hockey
Indoor Soccer
Netball
Petanque
Rugby
Shooting
Soccer
Softball
Table Tennis
Tag/Rippa Rugby (new)
Touch Rugby
Volleyball
Wallball
Sport #3
Please Select
Archery
Athletics
Basketball
Bowls
Croquet
Cross Country
Darts
Hockey
Hole in 1 golf
Indoor Hockey
Indoor Soccer
Netball
Petanque
Rugby
Shooting
Soccer
Softball
Table Tennis
Tag/Rippa Rugby (new)
Touch Rugby
Volleyball
Wallball
Sporting Achievements
Brag about how good you are:
Emergency Contact Details
Name of Emergency Contact
*
Must be available 24 hours a day during the camp
Relationship to you
*
Phone Number
-
Area Code
Phone Number
Work Phone
Cell Phone
*
Medical Details
Specify any conditions that may effect you during camp and require special care:
Medical conditions
Medication - Specify any medication that you may be taking during camp:
Are you allowed to be administered Paracetamol?
*
Yes
No
Last tetanus shot Date:
Dietary
Dietary Requirements - vegetarian, dairy-free, nut-free, gluten-free, other food allergies etc:
Bus Service and Time
Submit
Should be Empty: