Kiama Central Netball Club – Player Registration Form 2017
Player Details
Given Name and Surname
Maiden Name (if applicable)
Date of Birth
School Details
School:
Year at School:
Preferred Position(s)
Previous Experience
WWCC Details
Clearance No:
Expiry Date:
Declaration Completed: Y or N
Parent Caregiver Details
Parents /Caregiver Name (s)
Mobile (s)
I would be happy to serve as Coach
No experience or qualifications needed. Help on hand and courses available through the Association.
Do you have your Foundation Coaching Accreditation? YES / NO
Year Assessed: _________________
I would be happy to serve as Team Manager
No experience or qualifications needed. Duties include scoring, mothering (players, coach, parents), arrange roster,
attend Club meetings.
I would be happy to learn how to Umpire
Lots of on the job training provided
Have you completed for the Umpire Theory Exam?
YES / NO
Year Passed:
Membership Type
Membership Type
(circle one)
Senior
Cadet
Intermediate
Intermediate
Junior
Modified
Net Set Go
Non Player
Cost
$200
$190
$180
$170
$150
$85
$50
Netball NSW Registration
Have you previously played netball in NSW? Yes ☐ No ☐
Last Club _________________________________
Do you have any other family members registering with Netball NSW? Please name below:
Name (s)
Net Set Go Players (10 years and under) T-shirt size ____________ example children size 6, 8, 10,12 etc.
Declaration
I DO☐ I DO NOT☐ - give permission for me/my child to be photographed and/or filmed and for photographs/film footage
to be used by Kiama Central Netball Club and its affiliates in promotional material and publication.
I believe, to the best of my ability, the information provided above is true and correct.
As a member (18years and over), and/or a parent/guardian of a member under 18years, I agree to abide by the Club’s and
Association’s Constitution and By-Laws, Codes of Behaviour, Member Protection policy, Sports Injury Policy (as presented on
the Club/Association website). I am aware of the risks of playing netball whilst pregnant or playing with a pre-existing
medical condition.
Signed:
Date:
CLUB USE ONLY
MyNetball ID
Fee $
Payment Type
Receipt no.
Kiama Central Netball Club – Player Registration Form 2017
The following information is required by Netball NSW for player registration.