______________________________________________________________________________ For further enquiries please contact: Matthew Sheldon-Collins High Performance Sport Coordinator Tel: 9548 8407 E-mail: firstname.lastname@example.org Monash University High Performance Sports Centre 13 Duerdin Street, Clayton VIC 3168. High Performance Junior Basketball Camp Elite Juniors Aged 14 to 17 years Map sourced from Google Maps Thursday 9 and Friday 10 July 9am - 3pm CRICOS provider: Monash University 00008C Disclaimer Monash University High Performance Sport Centre While the information provided in this brochure was correct at the time of its publication, Monash University reserves the right to alter procedures, fees and regulations should the need arise. www.sport.monash.edu Raise your game to the next level! Monash University High Performance Junior Basketball Camp application form Personal Details Want to increase your basketball level and unsure where to begin? Let Dale Waters and his coaching team develop your Given name: _______________________________ Surname: _________________________ basketball skills and knowledge to take your game to that next level. Gender: M / F Date of Birth: __ __ / __ __ / __ __ Position: _________________ Dale Waters (pictured below) is currently the Head Coach for the Women’s National Basketball Club and Highest Level Played: ____________________________________________ Basketball League Dandenong Rangers and Assistant Coach for the Australian u19 Junior Women. Dale and his coaching team will take players through the following Phone: (home) ____________________________ (mobile) ____________________________ over the two day camp: Email: _________________________________________________________________________ Address: __________________________________ Suburb: ___________________ PC: _____ • Basketball specific Physical testing and Benchmarking Payment Details • On Court Skill Acquisition & Development (Individual and team concepts) The cost of the High Performance Basketball Camp is $150. • Video analysis of Shooting Technique Cash: Cash and EFTPOS payments can be made at the Monash University High Performance Sports Centre,13 Duerdin St, Clayton. • Core Stability and exercise Physiology concepts Credit: Name on Card: _________________________________ Card type: Visa / Mastercard Card Number: __ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __ Exp: __ __ / __ __ Signature: _______________________ Date __ __ / __ __ / __ __ The cost of the High Performance Basketball Camp is $150. Participants will receive a training shirt, water bottle, lunch on both days, individual testing report, DVD of shooting analysis and core stability program. For more information on the High Performance Basketball Camp please contact Privacy Collection Statement Matthew Sheldon-Collins The information on this form is collected for the primary purpose of processing your application. Other High Performance Sport Coordinator purposes of collection include creation of a record on the database, attending to administrative matters Tel: 9548 8407 and corresponding with you. By completing all questions on this form, Monash Sport is able to process your application. Personal information may also be disclosed to the relevant banking institution for the E-mail: email@example.com processing of your payment. You have the right to access personal information that Monash University holds about you, subject to any exceptions in relevant legislation. If you wish to seek access to your Application forms can be submitted via fax 9905 4104 or posted to Monash University personal information or inquire about the handling of your personal information, please contact the High Performance Sports Centre, 13 Duerdin St, Clayton 3168. Monash Sport Privacy Officer on 9905 8837 or firstname.lastname@example.org.