Registration
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ETTS BACK AT IT BOOTCAMP WORKSHOPS Date: 21, 22 & 23 Jan 2025 Venue: Ettingshausens Cost: Bootcamp costs stipulated in Camp email & in the `Question' section of registration. Student enrolment based on AGE as at January 1, 2025. Pocket Rockets (5-6yrs) - 9.30am-12.00pm Dreamers (7-10yrs) - 9.00am-2.30pm Gamechangers (11-14yrs) - 9.00am- 3.30pm PRO Track (Yr 10+) - 9.00am-3.30pm
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State/Prov:
*
Postal Code:
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=dd/mm/yyyy)
School:
*
:
*
Adult
Kindergarten
Preschool
Year 1
Year 10
Year 11
Year 12
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Allergies (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=dd/mm/yyyy)
School:
*
:
*
Adult
Kindergarten
Preschool
Year 1
Year 10
Year 11
Year 12
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Allergies (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=dd/mm/yyyy)
School:
*
:
*
Adult
Kindergarten
Preschool
Year 1
Year 10
Year 11
Year 12
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Allergies (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=dd/mm/yyyy)
School:
*
:
*
Adult
Kindergarten
Preschool
Year 1
Year 10
Year 11
Year 12
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Allergies (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Birth Date:
*
(format=dd/mm/yyyy)
School:
*
:
*
Adult
Kindergarten
Preschool
Year 1
Year 10
Year 11
Year 12
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Allergies (Leave blank if NONE):
Questions/Options:
POCKET ROCKETS - (5-6YRS) - age as @ 1 Jan 2025 Stipulate selected workshop option: Day Rate (day attending eg 21/22/23) - $65: 3-day package - $175:
DREAMERS - (7-10YRS) - age as @ 1 Jan 2025 Stipulate selected workshop option: Day Rate (day attending eg 21/22/23) - $100: 3-day package - $270:
*
GAMECHANGERS - (11-14YRS) - age as at 1 Jan 2025 Stipulate selected workshop option: Day Rate (day attending eg 21/22/23- $120: 3-day package - $310:
*
PRO TRACK- (Yr 10 ) - age as at 1 Jan 2025 Stipulate selected workshop option: Day Rate (day attending eg 21/22/23 - $120: 3-day package - $310:
*
Additional Information:
Other Questions/Comments:
Please fill out ONE of the following Payment Methods.
Credit Card Verification:
Card Number:
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Name as it appears on card:
Nickname:
Card Expiration Month:
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Exp Year:
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2054
Address Line 1:
Address Line 2:
City:
State/Prov:
Postal Code:
eCheck/Bank Draft:
Bank Name:
Bank State Branch (BSB) Number:
(6-digit number)
Your Account Name:
(Your name on your bank statement)
Your Account Type:
Checking
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Account Number:
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