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Maria Ziedina
2021-12-01T16:18:21+10:00
Registration
Participant Registration Form
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Program Details
Select a Program
*
- Select a Program -
TAS - Launceston Lanes (Friday 2pm)
VIC - Oz Tenpin Shepparton (Mon 1:30pm)
VIC - ZONE BOWLING Forest Hill (Wed 5:30pm)
WA - Bunbury Tenpin Bowl (Tues 1pm)
WA - Bunbury Tenpin Bowl (Tues 5pm)
WA - ZONE BOWLING Joondalup (Tues 5pm)
WA - ZONE BOWLING Morley (Mon 5pm)
Other
Select a Program
Term
*
- Select a Term -
Term 2
Term 3
Year
*
2022
State
*
- Select a State -
Western Australia
Victoria
Tasmania
South Australia
Northern Territory
New South Wales
Queensland
Australian Capital Territory
Is this the first time the participant has registered for Bowl Abilities?
*
Yes
No
Are you the participant?
*
Yes
No
Participant Details
Name
*
Name
First
First
Last
Last
Date of Birth
*
Gender
*
Male
Female
Prefer not to say
Was the participant born in Australia?
*
Yes
No
No
Does the participant identify as Aboriginal and/or Torres Strait Islander?
*
Yes
No
Does the participant have any allergies/medical conditions?
*
Yes
Yes
No
Does the participant identify as living with a disability/disabilities?
*
Yes
No
Does the participant require any specific support?
*
Yes
Yes
No
Number of days the participant is active per week
*
0
1-2
3-5
5+
What is the participant's preferred communication style?
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Parent/Carer Details
Name
*
Name
First
First
Last
Last
Relationship to participant
*
Parent/Guardian
Support Worker
Other
Other
Were you born in Australia?
*
Yes
No
No
Who is the primary contact for program details?
*
Participant
Parent/Guardian
Support Worker
Other
Other
Email
*
Phone
*
Contact Details
Email
*
Phone
*
Emergency Contact
*
Emergency Contact
Name
Name
Mobile Phone
Mobile Phone
Emergency contact relationship to participant
Parent/Guardian
Support Worker
Other
Other
Payment Details
Program Cost
Four Session Program - 40 AUD
Six Session Program - 60 AUD
Eight Session Program - 80 AUD
Preferred payment method
*
Pay by Credit Card
Pay by Voucher
Total
Voucher Code
*
Credit Card
*
Card Number
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