General Information

Please note that Player Mobile phone and Emergency Contact Ph number collected

will be used for communication via Whatsapp for ease of communication.

Athlete First name *

Athlete Surname *

Date of Birth *

Athlete Email Address *

Gender *

MaleFemale

Athlete Mobile phone *

Athlete Postcode *

How did you find out about us? *

T-Shirt Size *

SMLXL

Emergency Contact Information

All program-related communication and invoices will be sent to this email address and phone number.

Emergency Contact Name *

Phone *

Emergency Contact’s relationship to you *

Development Program Details

Development Program - 10 weeks (14th October 2024 to 20th Dec 2024)

Program Features :

Warm Up (S&C)
Weekly Skill stability sessions
4 phase program - 90 minutes
- Technical Strength / Max Speed / Transfer Strength + Tactical
Includes strength + conditioning drills, bowling development and skill stability
24/7 access to the Gym for Students as well as Parents (during your childs session) - Introductory offer for this season

Select Your Program *

10 Weeks - Development Program - 1 session per week (Oct 2024 - December 2024) - $75010 Sprint Session (Oct 2024 - December 2024) - $200

Select Development Program Payment Option

Payment Option (Development Program) - 1 session per week *

Upfront via Bank Transfer - 10 weeks - $750Monthly Direct Debit (3 payments) - $250 / monthWeekly Direct Debit (10 payments) - $75 / weekn/a

Sprint Program

10 sessions @$200 (upfront)10 sessions - $20/week10 sessions - $100/weekn/a

*Direct Debit form will be sent to your email address for your authorisation shortly.

Athlete Information

Current Work Status *

StudentEmployedAthlete Not working

Occupation

Athlete Current Club *

Health Fund Details

Will you be claiming the Physio & Rehab sessions via your Health Fund ? *

YesNo

Health Fund Provider Name

Health Fund Membership No

Current Injuries

Any Current Injuries ? *

YesNo

Location of Scans, if any ?

Are you claiming Sport insurance ?

YesNoNot Sure

Consent

I confirm that above information I have provided is true, complete and accurate. If I choose a program Power and Pace offers, then I will be provided a teambuildr code via my (Athlete) whatsapp and I (Athlete) will be added to the Power and Pace Whatsapp group. *

I grant Power and Pace a non-exclusive, royalty-free license to use photos and videos of me solely for the purpose of promoting Power and Pace programs on social media platforms. *

Signature

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