Bundeena Maianbar Football Club
Summer Football 2016 Registration Form
Section A – Player details
School year (eg Yr 4)
Date of birth
First name
Last name
Contact mobile no.
Email
Played with BMFC in Winter 2016?
☐Yes – go to section C
☐No – complete details below
Address
Parent/emergency
contact name
Parent/emergency
contact phone no.
Has the player ever played for an SSFA club?
☐No
☐Yes–Year last played & club ________________________
Is the player Aboriginal or Torres Strait Islander?
☐Yes ☐No
Does the player have a disability?
☐Yes ☐No
Section B – Payment
Payment
Cash
method
☐
☐Cheque ☐MasterCard ☐Visa card ☐Other credit card ☐Direct debit
Credit card
details
Name on card
Expiry date
Card number
CVV
Amount ($50 per player)
Bank details: BSB: 824-000 Account: 33009662 Name: Bundeena Maianbar Football Club Ref: Summer - name
Section C – Declaration
I understand that participating in the activities of Bundeena Maianbar Football Club carries with it the inherent risk of
physical injury, including serious injury such as permanent disability, paralysis and even death. In consideration of
being allowed to participate in the activities of the club, I hereby agree to release and hold harmless Bundeena
Maianbar Football Club in the event of my/my child’s injury. I have read and fully understand this waiver and agree to
release Bundeena Maianbar Football Club from liability for any injury or other losses I/my child incurs, including the
club’s acts of negligence to the fullest extent permitted by law.
I agree to the use by BMFC of any photos or video taken during the season for the BMFC website, social media or other
publicity.
Print name (of parent/guardian if under 18 years)
Signature (of parent/guardian if under 18)
Date
/
/2016