Registration Form

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Please fill out the form to register your attendance at the 13th Beach Health Service Prep to Play Footy Day on Saturday 3rd December 11AM to 4PM at Barwon Heads Football Club.

The format of the day (subject to registrants) is as follows:

11 AM - 1 PM: Football training session - all ages. Drills will be designed to partner similar ages

1 - 2 Lunch: BBQ provided

Coaches: Claudia Gunjaca (Physiotherapist 13th Beach, Geelong AFLW Player), Olivia Fuller (Myotherapist, Geelong AFLW Player), Brooke Patterson (Physiotherapist, coach, former Melbourne AFLW player and coach, Prep to Play project manager, researcher at La Trobe University), and David Proctor (Director, 13th Beach Health Services).

Football sessions include:

Prep to Play Warm Up
Fundamental rotations: tackling, kicking, ground balls
Small-sided games
Goal kicking competition - parents invited! Win a XXXX
Prep to Play Strength program

You will receive confirmation and details about the day 48-72 hours after you complete the registration, and 1 week prior to the event.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.