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Which Academy are you registering for? *

Full Player's Name *

Parent's Full Name *

Parent's Email Address *

Parent's Mobile Number *

Home Address *

Player's Current Club and Age *

Apparel Sizing

Player Shirt Size *

Player Short Size *

Attendance

Attendance Selection *

1 Day Per Week

2 Days Per Week

Payment Details (Direct Debit)

Your bank details will be used for direct debit payments only. All information is stored securely.

BSB *

Account Number *

Account Name *

I authorise Premier Rugby League Academy to deduct the agreed fees from the above bank account for the duration of my registration.

Would you like to register for the performance extras which include Mental Performance and Sports Nutrition programs? (Cost - $10 per week).

Additional Information

Additional Needs, Medical Conditions or Developmental Concerns

How Did You Hear About Us?

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