Expression of Interest
First Name
Last Name
Date of Birth
Gender
Male
Female
School Grade
-- None --
Infant - Birth to 1yr
Baby - 1 to 2 yrs
Toddler - 2 to 3 yrs
Preschool - 3 to 4 yrs
Kindy - 4 to 5 yrs
Reception - 5 yrs
1
2
3
4
5
6
7
8
9
10
11
12
Parent/Guardian Information
Parent/Guardian Name
*
Parent/Guardian Contact Email
*
Parent/Guardian Contact Number
*
Additional information to help us get to know you and your child
How did you find out about Hope Valley HEAT?
*
Friend (include name in comments)
Website
Church
ACBA
Other (add details in comments)
Why are you wanting to join our Club?
*
Faith-based club
Friendship
Church
Other (add to comments below)
Is your child currently playing basketball; if yes, for who?
*
How long has your child been playing?
*
Please advise your childs basketball experience?
*
Beginner
Medium
Advanced
Are there any special needs we need to be aware of to help support your child?
*
As a parent/guardian; are you prepared to be involved and volunteer within the club?
*
Yes
No
Comments
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