OTAGO NUGGETS APRIL SCHOOL HOLIDAYS BASKETBALL CAMP

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Please complete a separate online form for each registration.

Venue: Edgar Centre, Dunedin

Dates: Tue 11 Apr, Wed 12 Apr, Thu 13 Apr, Fri 14 Apr

Ages: Year 7-13 only

Time: 12noon to 3pm

Cost: $40.00 per day or $160.00 for all 4 days

** Register for all 4 days and receive a free t-shirt

Registrations close: Thursday 6 April

Bank Account Name: Sports Entertainment Network NZ Limited
Bank: ASB Bank
Account Number: 12-3107-0082919-00
**please ensure you put "April Camp" and your child's name as a reference on your deposit.

Email *

First Name *

Surname *

Contact Phone Number *

School Year / Age Group *

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Year 13

Emergency contact name, email & phone number *

Select which camp dates attending: *

Tuesday 11 April 12noon-3pm - Cost $40.00

Wednesday 12 April 12noon-3pm - Cost $40.00

Thursday 13 April 12noon-3pm - Cost $40.00

Friday 14 April 12noon-3pm - Cost $40.00

All 4 days - Cost $160.00 (receive a free t-shirt)

Required

If you registered for ALL 4 DAYS please select your free t-shirt size

Small (47cm width / 70cm length)

Medium (52cm width / 74cm length

Large (56.5cm width / 77.5cm length)

XL (61cm width / 81cm length)

2XL (64cm width / 84cm length)

Clear selection

I give permission for my child's photo / video's to be used for promotional purposes. *

Yes

Does your child have any medical issues we should know about? *

Yes

Name of City/Town where you live *

Further Comments

A copy of your responses will be emailed to the address you provided.

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