New Player Registration
Form
Summer 2014/2015
All new players must also complete a Kilsyth
Basketball Registration (Purple) from
http://www.kilsythbasketball.com.au/fileadmin/
user_upload/Menu_Headers/Resources/KMDB
A_Membership_Form.pdf
All new players need to contact the boys or girls coordinator before completing this form.
Boys Coordinator: Kath 0434 056 456
Girls Coordinator: Jane 0439 561 559
Uniforms: Lockerroom Kilsyth Stadium 9728 1033
Payment and Registration form can be posted to PO Box 100 Croydon 3136 or delivered to the club registrars
Scott and Sara Stelfox 5 Todd Court Croydon 9722 9048.
PARENT/GUARDIAN DETAILS Registration will not be accepted if details are not complete
SURNAME:
FIRST NAME:
SURNAME:
FIRST NAME:
EMAIL:
ADDRESS:
SUBURB:
POSTCODE:
PHONE:
PLAYER DETAILS
PLAYER NAME:
BIRTHDATE:
DO YOU PLAY REPRESENTATIVE BASKETBALL? (eg Cobras,
Hawks or Venom)
No
Yes
If Yes, in what grade do you play:
GENDER
Male
PLAYER NAME:
BIRTHDATE:
DO YOU PLAY REPRESENTATIVE BASKETBALL? (eg Cobras,
Hawks or Venom)
No
Yes
If Yes, in what grade do you play:
GENDER
Male
PLAYER NAME:
BIRTHDATE:
DO YOU PLAY REPRESENTATIVE BASKETBALL? (eg Cobras,
Hawks or Venom)
No
Yes
If Yes, in what grade do you play:
GENDER
Male
/
/
/
/
/
/
Female
Female
Female
PARENT SURVEY
Are you interested in learning to coach
YES / NO
Would you be interested in being a team manager
YES / NO
PARENT DECLARATION
I understand that medical assistance for my child may be sought by a responsible adult if I cannot be contacted
in case of an emergency, and that I will be rostered to assist my child’s team by scoring at games and providing
adult attendance at training sessions. http://www.sportingpulse.com/club_info.cgi?client=1-179-39616-00&sID=222536&&news_task=DETAIL&articleID=16398646
Signature
Date
PLAYER DECLARATION
Players’ Code of Conduct
I have read, understood and agree to adhere to the Scorpions Code of Conduct.
Players’ Code of Conduct can be viewed online at http://www.sportingpulse.com/club_info.cgi?client=1-179-39616-00&sID=222536&&news_task=DETAIL&articleID=16398644
Signature
Signature
Signature
Signature
FEES
Miniball (under 7 and under 8)
Junior Players 1 Player $75
$45 (first season of miniball is free)
2 Players $125
3 Players $155
4 Players $185
PAYMENT DETAILS Internet Banking Direct Deposit, Cheque or Money Order is preferred. Cash will
also be accepted, contact Registrars to arrange payment by cash.
CHEQUE (must be made payable to South Croydon Youth Club Inc)
MONEY ORDER (must be made payable to South Croydon Youth Club Inc)
INTERNET BANKING DIRECT DEPOSIT
(follow instructions below)
INSTRUCTIONS FOR Internet Banking Direct Deposit Payment
Account Name: South Croydon Youth Club Incorporated BSB: 033 044 Account number: 860 206
Please ensure you clearly provide your Surname and ‘rego’ as the reference in the transaction
eg. Stelfox rego.
NOTE: Players will NOT be covered by insurance or placed in a team until the completed form and payment
has been lodged with the club.
CLUB USE ONLY
Amount Received:
Date Received:
Receipt No:
Cheque No:
Database entered:
Authorised By: