- Registration

Parent / Guardian Details

First Name

Last Name

Mobile

Street Address

City/Suburb

State

Zip/Postcode

Participant Details

First Name

Last Name

Gender

Male

Female

Date of Birth

Address same as Parent / Guardian

Street Address

City/Suburb

State

Zip/Postcode

CAMP DETAILS:

How did you hear about Heartland Hoops?

Have you ever attended a Heartland Hoops event previously?

Returning participants are kindly asked to bring their NBL24 green Heartland Hoops drawstring backpack to camp, new participants will receive theirs at registered event.

What would best describe the participant's experience level?

Your answer will help guide us to assort participants into groups with similar age, skill and confidence levels.

What would best describe the participant's on-court confidence level?

Your answer will help guide us to assort participants into groups with similar age, skill and confidence levels.

Please leave any camp-day group requests below (e.g "Please group with older brother and teamates)

Groups are assorted on camp-day by requests, age, skill, experience and confidence level in-order to boost participant enjoyment and engagement. Groups can be shifted by participant request throughout the camp-day.

What is your preferred Heartland Hoops t-shirt size?

Does the participant currently play in organized basketball (domestic, school, representative etc)? If applicable, please list team name e.g South East Eagles, if non-applicable please leave blank

Does your current team, club etc. fall under any of the associations listed?

If you selected "Other", please specify below if applicable.

Which school does the participant attend? (Optional)

Are you a SEM Phoenix member?

How often do you attend SEM Phoenix games?

Did you attended a Phoenix game-day this NBL24 season?

Please list any medical conditions or health concerns if required:

Will the participant/s be bringing any required medication to camp?

Emergency Contact Details

Full Name

Mobile

Payment Summary

Event	Price	Quantity
	$165.00	1
Promotion Code
TOTAL TO PAY: $165.00 (AUD) Inc. tax $15.00

Credit Card Details

Accepted Credit Card

Card Type*

VISA

Mastercard

AMEX

Name On Card

Card Number

Expiry Date

Security Code

By clicking on the submit button, I agree to the terms and conditions

CAMP DETAILS:

TOTAL TO PAY: $165.00