Yara Family Connections
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School Holiday Clinic Booking Form
Yara Basketball Academy Registration
Yara Basketball Academy
About this form
This form is used both as a registration form for the program AND as your sports voucher registration form. All information is kept confidential in line with our privacy policy. We respect that there are questions in this form that may be sensitive. Some questions are only asked as part of the sports voucher eligibility criteria and will only be visible if selecting to use your sports voucher. We are here to help, if you would like support with this form please contact us on 0403 630 123 and we will assist with your registration.
About the Athlete
Athlete's Name
(Required)
First
Last
Gender
(Required)
Select your gender
Male
Female
Transgender
Nonbinary
Genderfluid
Prefer not to say
Date of Birth
(Required)
DD slash MM slash YYYY
Your Address
(Required)
Street Address
City
ZIP Code
Would you like to use your School Sports Voucher for this program?
(Required)
Yes
No, Please invoice me the full amount
Does the Athlete hold an Australian Visa?
(Required)
Yes
No
Please provide your Visa Number
(Required)
Please provide the Athlete's Medicare Number
(Required)
Does the Athlete have a disability?
(Required)
Yes
No
Please share a little more about the disability so we can best support your athlete
(Required)
ADHD
Autism Spectrum Disorder
Physical
Social / Emotional
Intellectual
Other than listed
Does the Athlete identify as Aboriginal or Torres Strait Islander?
(Required)
Yes
No
Who is your Mob?
Is English the main language spoken at home?
(Required)
Yes
No
Bi/Multi Lingual
What is your prefered language?
(Required)
Please share a little about the Athletes current skill level
Information such as District level, or domestic. Number of years playing can help with correct class placement
Athlete will be assessed in the initial session to best support group placement and best learning opportunities. Is there any informaion about your availability that is important for us to know?
Session Request
I would like to book for the AJBL Winter Season Come N Try day Monday 13th April
u12's & u14's | 10am - 11.30am
u16's & u18's | 11.30am - 1pm
Come and meet our coaches, learn about our programs and receive information and support on registration options.
I would like to book for the YBA Academy:
Term 2: Saturday 10am-11am (Advanced group Mixed u10-u14)
Term 2: Saturday 11am-12pm (Advanced group Boys u16-u18)
Term 2: Tuesday 4.30-5.30pm (general group u14-u18 boys)
Term 2: Tuesday 5.30-6.30pm (general group u10-u14 mixed)
Please note Weekday groups are charged at $180 per term ( equals $20 per session). Weekend groups are charged at $220 per term (equals $27.50 per session). This is due to the increased court hire cost for weekends.
About the Caregiver
Caergiver Name
(Required)
First
Last
Caregiver Phone
(Required)
Caregiver Email Address
(Required)
About this form
This form is used both as a registration form for the program AND as your sports voucher registration form. All information is kept confidential in line with our privacy policy. We respect that there are questions in this form that may be sensitive. Some questions are only asked as part of the sports voucher eligibility criteria and will only be visible if selecting to use your sports voucher. We are here to help, if you would like support with this form please contact us on 0403 630 123 and we will assist with your registration.
About the Athlete
Athlete's Name
(Required)
First
Last
Gender
(Required)
Select your gender
Male
Female
Transgender
Nonbinary
Genderfluid
Prefer not to say
Date of Birth
(Required)
DD slash MM slash YYYY
Your Address
(Required)
Street Address
City
ZIP Code
Would you like to use your School Sports Voucher for this program?
(Required)
Yes
No, Please invoice me the full amount
Does the Athlete hold an Australian Visa?
(Required)
Yes
No
Please provide your Visa Number
(Required)
Please provide the Athlete's Medicare Number
(Required)
Does the Athlete have a disability?
(Required)
Yes
No
Please share a little more about the disability so we can best support your athlete
(Required)
ADHD
Autism Spectrum Disorder
Physical
Social / Emotional
Intellectual
Other than listed
Does the Athlete identify as Aboriginal or Torres Strait Islander?
(Required)
Yes
No
Who is your Mob?
Is English the main language spoken at home?
(Required)
Yes
No
Bi/Multi Lingual
What is your prefered language?
(Required)
Please share a little about the Athletes current skill level
Information such as District level, or domestic. Number of years playing can help with correct class placement
Athlete will be assessed in the initial session to best support group placement and best learning opportunities. Is there any informaion about your availability that is important for us to know?
Session Request
I would like to book for the AJBL Winter Season Come N Try day Monday 13th April
u12's & u14's | 10am - 11.30am
u16's & u18's | 11.30am - 1pm
Come and meet our coaches, learn about our programs and receive information and support on registration options.
I would like to book for the YBA Academy:
Term 2: Saturday 10am-11am (Advanced group Mixed u10-u14)
Term 2: Saturday 11am-12pm (Advanced group Boys u16-u18)
Term 2: Tuesday 4.30-5.30pm (general group u14-u18 boys)
Term 2: Tuesday 5.30-6.30pm (general group u10-u14 mixed)
Please note Weekday groups are charged at $180 per term ( equals $20 per session). Weekend groups are charged at $220 per term (equals $27.50 per session). This is due to the increased court hire cost for weekends.
About the Caregiver
Caergiver Name
(Required)
First
Last
Caregiver Phone
(Required)
Caregiver Email Address
(Required)
