Office Use Only: Age Group
PINK PANTHERS NETBALL CLUB
REGISTRATION FORM
Registration week 9th June – 16th June
SPRING 2012 SEASON
If you do not return this form by Friday, June 16th 2012 you will not be put into
into a team for the Spring Season.
The Kingston District Netball Association (KDNA) requires Spring Season team
registrations to be submitted by early July. In order to submit the right number of teams
and co-ordinate coaches, we need to know if you will be playing next season. Pink
Panthers will be having a registration week from 9th-16th June.
Childs Name
Date of Birth
Age at 30/06/2012
Parents Names
Address
Email Address
Please Tick if you
would like to receive
Home Phone:
Newsletter Via Email
All correspondence via email
Work Phone:
Do you currently play for Pink Panthers
Mobile:
Yes
No
If yes please provide details of current season team: Age group ________Coach _____________
Please list any special requests to be considered in the team selection process
ie: availability for training etc.
FEES: To be paid by during registration week 9th-16th June.
VNA (Annual Fee): Only payable for new players to the club for the Spring Season
$30 turning 8-11 years in 2011
$40 turning 12-17 yrs in 2011
$55 turning 18yrs or over in 2011
Season Game Fees:
Training Fees:
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$35.00 Netta teams
$95.00 All other teams
$50.00 All teams
Protecting your Privacy – Privacy Act
“The information collected in relation to participants will be held in accordance with the information
privacy principle contained in the Privacy Act 1988. The Mordialloc Community Centre shall ensure
that it compiles with such information privacy principles and shall not disclose any such information
except in accordance with the provisions of the Privacy Act.”
Enrolment Policy
Activities with limited places, eg: Kindygym, Gymnastics, Special Programs.
- an enrolment will only be secure with a non-refundable deposit
- enrolment must be renewed at the end of a term for the next term
Team Sports, eg Basketball, Netball
The season fees must be paid prior to the season commencement. Fees paid after this time will incur a $10
levy.
Refund Policy
Deposits are non-refundable.
Term Fees - Refunds will be given prior to commencing an activity with 7 days notice. Refunds are not given
once activities have commenced unless someone fills your place. A $20 administration fee will apply to all
refunds.
Special circumstances will be considered at the manager’s discretion.
Waiting Lists
Waiting lists are kept for full classes and places filled in order. All possible effort is taken to contact people in
order. Places are only held for one week.
THE MANAGER
January 2012
PHOTO PERMISSION:
Please Note: if you do not sign this authority. your child will be excluded from relevant photo/video opportunities
but not from the activity.
As the parent or guardian of ________________________________________,
I do hereby assign all rights, privileges, and materials for reproduction to Mordialloc Community Centre for any
or all photographs taken of the above named minor by Mordialloc Community Centre or its recognized agents. I
further grant Mordialloc Community Centre the right to use my child's name and likeness in the publication
and/or Web site and related products and services for the promotion of the Mordialloc Community Centre and
its activities.
Signature:
Name (Printed):
INDEMNITY FORM - PLEASE SIGN
In consideration of the Mordialloc Community Centre, accepting the above named as a member, I
agree and do hereby indemnify the Mordialloc Community Centre, its Officer, Servants or Agents
from and against any damages, claims or demands arising out of any accident or illness which may
befall or occur to the said member during his/her participation in any activity or function connected
with the Mordialloc Community Centre or when travelling to and from such activities or functions. I
further authorise any Officers or Servants of the Mordialloc Community Centre in the event of such
illness or accident to obtain any necessary medical assistance or treatment, and for this purpose
engage any doctors, nursing assistance or hospital accommodation, and in this event, I agree to pay
all such doctors, nurses, or hospital fees and expenses incurred.
Signed: ___________________________________________
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Date: _____________