Vector Health

Athlete Development - Running Specific - Speed, Agility, Running Technique and Fitness - Term 1 - 2017

Athlete/Client 1

Athlete/Client Details

Athlete/Client First Name

Athlete/Client Last Name

Date of Birth

Gender

Email Address

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Create your password

Enter the password that you would like to use for your new account.

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Home Phone

Mobile/Cell

Parent/Guardian Details

Mother's Name

Mother's Email Address

Mother's Mobile/Cell

Father's Name

Father's Email Address

Father's Mobile/Cell

Address

Address 1

Address 2

Suburb/Town

State/Prov

Zip/Postcode

Health and Fitness

Do you have any injury concerns?

Do you have any medical conditions?

Sport (if applicable)

How did you hear about us?

Training Dates

From 22-Jan-2018 to 30-Mar-2018

Training Days & Times

Once a time slot is full you will be asked to make another choice.

Time	Mon
4:30 - 5:30 pm	Speed - Agility - Fitness Session Victoria Park - Huish Drive - Rockhampton

DISCLAIMER:
This is a running specific program. We aim to increase your knowledge of technique and how this applies to going faster. We expect your commitment and your dedication to success. You will get homework to do as part of the program. Not much, but a little bit regularly! We look forward to helping you run faster!

Agreement

Signed (Parent/Guardian)

Date

/ /

Payment Method

There are no refunds for any enrolments into Vector Health related programs. When you sign/tick confirmation for this enrolment you are acknowledging that you know this as a fact and have accepted it as a condition.

Cost

$150.00 1 Session per week focused on technique, speed, agility and fitness specific to sport

Cost Per Person

$0.00

Total Cost

Group Discount

Grand Total

PayPal (Credit Card or PayPal Account)

Credit Card (Ezidebit)

Please mail this form with a payment attached to: "Vector Health, 102 William Street , Rockhampton QLD 4700"