MAZENOD BASKETBALL
PLAYER REGISTRATION FORM
SEASON
1
(TERM 1&2)
2
(TERM 3&4)
(PLEASE CIRCLE)
Player Details
Player Name: ______________________________________
D.O.B. ______________________
Boarder / Day (please circle)
School Year: ______________
Club last season: ____________________
Team last season: ______________________
Comment __________________________________________________________________________
__________________________________________________________________________________
Parent / Guardian Details
Name:
____________________________________________________
Address: __________________________________________________________________________
Email:
____________________________________________________
(Email is our primary means of communication please provide an up to date and regularly checked email address)
Home ph: ____________________ Work Ph: ___________________ Mobile: ___________________
Our basketball teams can only exist with parent helping in various roles.
Please circle any option you can assist with: COACH / MANAGER / COMMITTEE
I acknowledge that there are risks involved in playing basketball and agree to indemnify Mazenod
College of any liabilities it may suffer arising from any injuries or loss suffered by me or my children
arising out of any activity involving my children at the Club.
Parent / Guardian signature: _____________________________________
Date: __________________
PAYMENT MUST ACCOMPANY REGISTRATION and is to be returned to either the Mazenod School
Office either in person or by post. (Can be paid either with cash, by cheque or Direct Transfer
(Mazenod College: BSB 066112 : Acct No. 00900369 - With a description of “MBC – student name” (eg. MBC D
Brown).
If paying by cheque, please make it out to Mazenod Basketball Club.
Cost:
$70.00 per player.
Preference is given to players who are financial. No PAY no PLAY.
This includes team nomination to KDBA, equipment costs and windup.
Official Use Only
Fees Paid Date: _________________
CASH / CHEQUE / CREDIT/DIRECT TRANSFER
(Please circle method of payment)
TEAM: