ELIGIBILITY PRICE Open to all boys and girls 13 – 17 years. $550 per person including GST. (Minimum 3 years cricket experience at Club and/or School level required) PAYMENT DETAILS DATES AND TIMES Payment can be made via: The Clinic dates are: *Cheque *Credit Card 14 – 16 January 2015, All payments must be accompanied by a completed Days 1 & 2: 2pm to 7pm Day 3: 2pm to 5pm Registration Form. A letter will be forwarded to you (Dinner included on days 1 and 2) upon receipt of payment as confirmation of your booking. PROGRAM WHAT TO BRING Program will include specialist skill development including game • Cricket shirt/cricket pants/shorts sense tactics, nutritional advice, strength and conditioning • Cricket Equipment (pads, gloves, box, bat, helmet) fundamentals and individual player analysis with all sessions being facilitated by Queensland Cricket Coaches (Level 3 accredited). • Sunscreen and cricket hat • Drink bottle LOCATION Allan Border Field, Queensland Cricket Headquarters, SAFETY 1 Greg Chappell Street, Albion. The game of cricket is potentially dangerous and although injuries can occur, these are not common events. WHAT YOU RECEIVE QUEENSLAND CRICKET • Quality coaching by the Queensland Cricket High Performance HIGH PERFORMANCE CAMP Unit, including sessions at the National Cricket Centre CHRISTMAS SCHOOL HOLIDAYS • Official Training Shirt and cap 14 – 16 JANUARY 2015 • Certificate of Attendance • Written Skills Report • Dinner included on days 1 and 2 qldcricket.com.au REGISTRATION FORM MEDICAL HISTORY PARENT CONSENT I wish to attend the following Queensland Cricket High (Please tick appropriate box(es) I hereby authorise Queensland Cricket and its Performance Camp: Do you suffer from any medical condition/s or do you have any employees to act on my behalf should my child require *one registration form per attendee dietary requirements staff should be aware of? medical attention. I acknowledge, agree and confirm 14 – 16 January 2015 (Days 1 & 2: 2pm – 7pm, Day 3: 2pm – 5pm) Yes. Please attach details the following: (Please print clearly.) No a) That there are inherent risks associated with the program which may result in my child being injured Contact in case of emergency: Name: including in a serious manner. I fully accept and agree to bear these risks. Date of Birth: / / Gender: M F Name: b) To the full extent permitted by the law I agree Address: Phone: both on behalf of my child and my own rights to indemnify, release and discharge Queensland Suburb: Post Code: PAYMENT DETAILS Cricket and its employees from any and all liability for any injury, loss or damage to my child however Please indicate your method of payment (tick one box) Phone: caused arising out of my child’s participation in the Cheque – Make payable to Queensland Cricket Association program including without limitation as a result of Email: Credit Card – Please complete details below negligence by Queensland Cricket. CRICKET HISTORY Amount: $550 c) That photos taken of my child at the clinic(s) may (includes Clinic Price and Merchandise total. Also includes GST) (Please tick appropriate box(es) be used by Queensland Cricket for marketing and publicity purposes. I have 3 years cricket experience. Cardholder’s Name: Mastercard Visa Signed: Club: Credit Card No: Name: School: Please provide a brief outline of your cricket history Date: Card Check Value: Expiry Date: / (Please note – applications cannot be accepted without *last 3 digits on back of card parental consent) Card Holder Signature: Once completed, please forward this Registration Form with payment to: Mail: Queensland Cricket High Performance Camp Please tick your shirt size: ATTN: Kellie Niebling Queensland Cricket Kid Sizes 12 14 16 PO Box 575 Men Sizes Small Medium Large ALBION QLD 4010 (Shirts are pre-ordered and exact sizing cannot be guaranteed) Fax: 07 3262 9160 Email: [email protected] QUEENSLAND CRICKET HIGH PERFORMANCE CAMP.