Keebra Park SHS Rugby League Program

Keebra SHS main website

23/02/2012 8:12:08 AM

Australia's Leading Rugby League Program

07 55 092 555

KEEBRA PARK SPORTS SPECIALISATION IN RUGBY LEAGUE

Features

	Program History
	Coach's Interview
	"Arrive Alive Cup"

EXPRESSION OF INTEREST FORM

Sports Specialisation Rugby League

If you would like to express an interest in the Keebra Park Rugby League Sports Specialisation Program please fill out the form below and we will review your request:

PERSONAL DETAILS

NAME:
*EMAIL:
DATE OF BIRTH:	Day: Month: Year: (example: 01 07 1995)
ADDRESS:
HOME PHONE NUMBER:
MOBILE PHONE NUMBER:
HEIGHT:	CM
WEIGHT:	KG
ANY MEDICAL CONDITIONS:
DO YOU HOLD A NEW ZEALAND OR AUSTRALIAN PASSPORT:	Australian New Zealand (Please tick if yes).

PLAYING DETAILS

PREFERRED POSITIONS:
CLUBS PLAYED FOR:
REPRESENTATIVE TEAMS PLAYED FOR:
ANY ADDITIONAL INFORMATION YOU MAY WISH TO ADD:

If you would like to download a form and fill it out later please click this link:

DOWNLOAD FORM HERE

Please send completed for to:

C/O THE RUGBY LEAGUE CO-ORDINATOR
KEEBRA PARK SHS
ANNE STREET
SOUTHPORT 4245
GOLD COAST QLD

DVDs OF YOU PLAYING RUGBY LEAGUE

DVDS MAY BE SENT TO:

KEEBRA PARK SHS
ANNE STREET
SOUTHPORT 4245
GOLD COAST QLD

For any further information please contact the school on 07 55 092 555