Registration
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ETTS BACK AT IT BOOTCAMP WORKSHOPS Date: 22, 23 & 24 Jan 2024 Venue: Ettingshausens Cost: Bootcamp costs stipulated in Camp email & in the `Question' section of registration. Instalment option available if registered by December 17. 1st Installment 18 Dec 2023 & 2nd Installment 11 Jan 2024. Early Bird Camp Rate: Expires 17 December 2023 Camp registrations after 17 December will be processed in full 11 Jan 2024. Student enrolment based on AGE as at January 1, 2024. Pocket Rockets (5-6yrs) - 9.30am-12pm each day Dreamers (7-10yrs) - 9-2.30pm each day Gamechangers (11-14yrs) - 9-3.30pm each day PRO Track (Yr 10+) - 9-3.30pm each day
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 2024 Stipulate selected workshop option: Day Rate (day attending eg 22/23/24) - $65: 3-day package - $175: Earlybird package (expires 17 Dec 2023) - $15
DREAMERS - (7-10YRS) - age as @ 1 Jan 2024 Stipulate selected workshop option: Day Rate (day attending eg 22/23/24) - $100: 3-day package - $270: Earlybird package (expires 17 Dec 2023) - $250
*
GAMECHANGERS - (11-14YRS) - age as at 1 Jan 2024 Stipulate selected workshop option: Day Rate (day attending eg 22/23/24- $120: 3-day package - $310: Earlybird package (expires 17 Dec 2023) -$290
*
PRO TRACK- (Yr 10 ) - age as at 1 Jan 2024 Stipulate selected workshop option: Day Rate (day attending eg 22/23/24 - $120: 3-day package - $310: Earlybird package (expires 17 Dec 2023) - $290
*
Additional Information:
Other Questions/Comments:
Please fill out ONE of the following Payment Methods.
Credit Card Verification:
Card Number:
Visa
Mastercard
Amex
Name as it appears on card:
Nickname:
Card Expiration Month:
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02
03
04
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06
07
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10
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Exp Year:
2024
2025
2026
2027
2028
2029
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2045
2046
2047
2048
2049
2050
2051
2052
2053
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
Savings
Account Number:
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