Queenstown Alpine Ski Team

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Email *

Athletes Name *

Date of Birth (example 01/12/00) *

DD/MM/YY

Gender *

Male

Female

School Attending 2017 *

Year at School 2017 *

Parent/Guardian 1 Name *

Parent/Guardian 1 Phone contact *

Mobile no Home no

Parent/Guardian 2 Name

Parent/Guardian 2 Phone contact

Mobile no Home no

Emergency Contact name (Cannot be Parent or Guardian) *

Emergency Contact No (Cannot be Parent or Guardian) *

Mobile no Home no

Athlete Residential Address *

Age Group and Programme (Deposit is non refundable) *

Speed Camp U14/U16 *

Yes my child will attending Mt Hutt speed camp. Estimated fee $1,200.00

No Thanks

Not Applicable

School Skiing for Year 8 and below excluding JA *

Yes my child will be attending QAST School Skiing 6 days $378.00

No Thanks

Not Applicable

Injury Insurance *

Yes, I want to pay the 4% insurance in addition to the base QAST fee

No, I don't want the injury insurance and understand by not paying it that the QAST injury refund policy will not apply to my athlete. That is, no refunds will be given for injuries. I also understand that I am required to pay the full season fees in the first instalment.

Payment Options. Non refundable deposit to be paid on the 15th March 2017, Instalment dates 1st June 2017 and 27th July 2017. *

If QAST invoices are not paid 10 working days after invoice due date, interest will accrue at 2% per month and credit cards will automatically be charged on the 10th day. Any issues with processing credit card payments will result in the athlete being withdrawn from training until full payment is received. All QAST athletes are required to submit valid credit card details to ensure invoice payments are duly paid.

Set up direct Credit - QAST, ASB Queenstown, Account no: 12-3405-0044099-00. Dates and amounts will be sent to you.

Payment via Internet - QAST, ASB, Queenstown, Account no: 12-3405-0044099-00. Please use your athletes name in the reference.

Credit Card (Visa or Mastercard only). Payment by Credit Card will incur a 2.2% bank processing charge.

Credit Card Details (Visa or Mastercard only). *

Name on card

Card Number *

Expiry Date (card must be valid for at least 12 months) *

Month/Year (example 01/18)

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