Winter Program - Wolverines Field Hockey Club

Winter Program

Children Info

Children Name *

Date of Birth *

Select Gender *

Total Price

AfterCount

BeforeCount

Discount

Parents/Guardian Name *

Relation to Child *

Email *

Contact Number *

Anything you would like to share about the child (e.g., allergies or other concerns)? *

Secondary Contact Number

Relation to Child

Address

{number-2} * 260(After 01 Dec 2018 born) + {number-3} * 360(Before 01 Dec 2018 born) = {number-1}

Discount: -{number-4}

Processing Fees: +{number-6}

Total Amount: {number-5}

Processing Fees

Price after discount

Credit / Debit Card *