38 Ashbury Cr, Mirrabooka WA 6061
P: 9205 7320
E: [email protected]
JUNIOR BASKETBALL
TEAM NOMINATION FORM
Team Name:
Must be 18 years or over and is responsible for all fees and
communication
Primary Contact
Name:
D.O.B:
Address:
Suburb:
Postcode:
Phone:
Mobile:
Email address:
Secondary Contact
Name:
D.O.B:
Address:
Suburb:
Postcode:
Phone:
Mobile:
Email address:
Competition
Please circle preferred day AND age group
Monday Basketball
Wednesday Basketball
Saturday Basketball
Under 12’s
Under 14’s
Under 16’s
Girls
Team Uniform
Shirt/Top colour
Boys
Penalty points will be awarded to the opposition for every
player out of uniform
Player Registration
Childs Name
Date of Birth
Parent Name and Phone Number
Team History
Have the majority of players participated as a team before?
Team Name:
Yes
No
Venue Played:
Conditions of Participation
Team registration must be paid by the third week of the competition.
Teams are committed for an entire season. Withdrawal will incur a $50 fee.
Forfeit fines apply. Please refer to the By-Laws for more details.
Abusive and threatening behaviour will not be tolerated at Stirling Leisure Centres.
Any inappropriate, threatening or abusive behaviour will be deal with by management.
Please read the By-Laws before signing the declaration below.
Declaration
On behalf of the team named on this form, I declare that we will participate in all matched
programmed for the duration of the season (including finals) and to honour all forfeit fines
and suspensions that may be imposed on this team by management. I declare on behalf of the
team that we understand that taking part in any sporting game comes with the possible risk of
injury and that the City of Stirling is not liable for any costs incurred by players as a result of an
injury suffered during the course of play. I further, being authorised by the team, agree to fully
indemnify the City of Stirling and all employees against any claims however arising which may
be made against them as a result of our teams, use of participation in or presence within the
Recreation Centre premises. Teams and individuals are responsible for arranging their own
personal accident or injury insurance. My team and I are also aware of the Bylaws that the City
of Stirling has in place.
Signed:
Date:
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