NEW PLAYER REGISTRATION FORM
First Name:
Family Name:
Date of Birth:
Home Phone:
Address:
Suburb:
Post Code:
Parent 1:
Parent 2:
Mobile :
Mobile :
Email :
Email:
Emergency Contact:
Mobile:
Relationship to child:
Previous Club:
Clearance Yes/No
pending:
Representative Player: (please tick) □ No
Rep Grade: (please tick) VC □
□ Yes Association: ________________
VJL □ (Metro 1 2 3 4 5)
REG □
I acknowledge that I have read and agree to be bound by the Membership
Rules (available from downloads page at www.berwickbasketballclub.com.au)
and all other by-laws of the Berwick Basketball Club. I acknowledge that I
make this statement on behalf of my child and both of the child’s
parents/guardians.
I give/do not give permission for any photographs taken by or on behalf of the
Berwick Basketball Club to be used for internal/external promotional
purposes.
Parent/Guardian’s Signature/s: ____________________________________
Print name/s: _________________________________Date: ____________
Club Use
Birth certificate sighted: yes/no Sighted by: _________ Fees: ______
Database updated ___/___/___ Season: ____________ Team: ______________
Berwick Basketball Club Inc. | Reg. No: A00221122Y │ PO Box 749 | Berwick 3806 │
Web: www.berwickbasketballclub.com.au | Email: [email protected]
Respect – Good Sportsmanship - Enjoyment