Incorporated Association Number: 5392 ABN: 55351430047
PO BOX 728 TOOWOOMBA Q 4350
2016 Player Registration Form
Player’s First Name: ___________________________ Surname :______________________________
Preferred Name : ______________________ Date of Birth: ______________ Team _____________
Email Address: ________________________________________________ Phone: _________________
Guardian Contact Details for Club Communication regarding training/events/emergencies
1. Name: ____________________________________________________ Relationship: _______________
Email Address:______________________________________________ Phone: ____________________
2. Name: ____________________________________________________ Relationship: _______________
Email Address:______________________________________________ Phone: ____________________
Please list any important information you would like the club to be aware of regarding your player. EG. Medical
conditions, Regular Medications, Specific Family Circumstances etc:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
______________________________________________________________________________________________
Things To Do To Complete Registration :
1. Register your player online via sporting pulse.
☐ completed
2. For players new to SSJRL please provide club with / upload copy of birth certificate.
3. For players who have played club rugby league before please see registrar
☐ completed
regarding transfer from previous junior club.
☐ if required
4. Payment of player fees $170 for first player and $150 for subsequent players in one family.
Payment by Cash/Cheque; Receipt # ____________
☐
Payment by Sporting Pulse Website; Receipt # ___________
☐
Payment by Bank Transfer; Receipt # ____________
☐
SSJRL Westpac Bank
BSB: 034-242 Acc # 165-524
Ref: Players Name
Payment by Get Started Voucher; Voucher # ____________
☐
5. Part payment of fees is available upon request. Minimum deposit is $50 each player must be paid before player
can train or play any games. Full fees must be paid by 14 April 2016
☐ request part
payment
6. Receive $30 Tru Sports voucher upon full payment of registration fees.
7. Understand and Agree to Player and Guardian/Supporter Code of Conduct.
Available on club website: http://www.southstigerstjrl.leaguenet.com.au
☐ voucher received
Guardian’s Signature: ________________________________________ Date: ____________________
Under 13 and over Player’s Signature: _________________________ Date: ___________________