September 2019 Indoor Clinic Registration Form
Those registering now will be put on a waiting list and be emailed Tuesday 24th September advising them if a space is available or not for Wed-Fri next week..
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CLINIC DETAILS    
DATES:   September 25-27
VENUE:  Pinelands High School (lonsdale way entrance)
TIMES:   Girls 09h00-11h30 daily
                Boys 12h00-14h30 daily
                If demand we add a 3rd session 14h30-17h00 daily which is typically a boys session or an older group session
COST:    R600
AGES:    9-13

Space is limited!

Primary Contact Email address *
Secondary Contact Email address
If primary does not work for some reason or other spouse...
Player Particulars
Player's First Name *
Player's Surname *
Date of Birth *
(NOT 2019!)  Type in year if struggling..
MM
/
DD
/
YYYY
School *
Father's (or guardian) Full Name
Mother's (or guardian) Full Name
Emergency Contact Cell Number *
Emergency Contact 2:
Are you a Goalkeeper? *
It is not a goalie specific clinic but if they join they will be involved heavily throughout the 3 days.
必填
Gender *
Indemnity
Therefore I hereby -

Acknowledge that I have familiarized myself with the nature and extent of the Sport and the risks and dangers to which I may be exposed as a result of my participation in the Sport;

Voluntarily assume the risks and dangers to which I may be exposed as a result of my participation in the Sport;

Indemnify and keep indemnified that PSI and/or its employees and/or agents against all injury, loss, damage, costs and/or expenses which I and/or any other person may sustain or incur as a result of my participation in the Sport; and

Agree not to hold the PSI and/or its employees and/or agents liable for any injury, loss, damage, costs and/or expenses, which I may sustain or incur as a result of my participation in the Sport.

Agree to make payment before the start of the clinic.

*
BANK DETAILS
PSI BANKING DETAILS -                          
Account name: Pro Series Sports
Bank: Investec Bank Limited
Branch name: 100 Grayston Drive
Branch code: 580105
Account number: 10011587895
Players name as a reference! (John Smith)

 COST: R600


Payment method *
(Please ensure to use the player's name as reference)
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