Registration Form 2009

Glen Waverley Soccer Club Website: www.glenwaverleysoccer.com Email: [email protected] Home Ground: Larpent reserve, Hammence st, Glen Waverley 3150

Player Registration 2009 Men’s Senior Competition Terms and Conditions Player Details Surname:

First Name: ______________________

DOB: __/__/____

Middle Name:_____________________

Address:__________________________________

Postcode: __ __ __ __

Email:____________________________________

Mobile:_________________

Home Phone:_________________ Emergency contact no.____________________ Parent/ Guardian Details (if under the age of 18) Mothers Name:____________________ Tel:_____________ Mobile:____________ Email: ___________________________ Occupation: ___________________ Fathers Name:_____________________ Tel:_____________ Mobile:____________ Email: ___________________________ Occupation: ___________________ I agree to receive emergency medical treatment if it be deemed necessary : I agree to my contact details and photographs to be listed on the Club’s WEB site: I agree to my contact details being shared within the Club to provide communication.

Yes / No Yes / No Yes / No

All players must pay their Full Registration Fee, including the full $50 Bond, prior to the first game of the season or they will become ineligible for team selection and remain uninsured. Special arrangements for payments may only be made by making representation to the Club Committee. (N.B. Football Federation Victoria requires all players to be registered at the time of entering into FFV competition.)

MEDICAL CONDITIONS I advise that the here said suffers from the following medical condition/s and we ask that this/these condition/s be brought to the attention of the Coach and Team Manager. Please provide asthma plan if your child is asthmatic.

Condition: ___________________ Medicare Number: ________________________ We, the undersigned, acknowledge that we have read, understood and accept the rules, terms and conditions of the membership fees. Players Name:_________________________________ Date: __/__/____ Players Signature:______________________________ Parent Guardian Signature: ________________________ Proof of Age sighted: Club Official Signature:__________________________________

YES / NO

Membership Fees 1st Player Fees

Amount Due

A. Registration

Amount Paid (min $150)

$300

……………..

…………….

…………….

.……………

……………..

...………….

B. Bond-Shirt and Infringement $50 Total:

$350

Balance

nd

2 Player Fees (only applies for a direct family member of the first player) A. Registration Fees

$200

.…………..

..……………

B. Bond- Shirt and Infringement

$50

..….………

……………..

$250

.…………..

……………..

Total:

I/We agree that if the Players shirt is not handed back to the club at the last game of season 2009, I/We forfeit our Bond of $50. I/We agree that any fines or penalties incurred throughout the season will forfeit the $50 Bond subject to committee review.

1st player Name:

Signature: ___________________

nd

2 Player Name: Payment Options:

Signature:___________________ Cash/ Cheque

Date: __/ __ /____

Cheque number: _________________________

How can you help? I would like to be: ( please circle one) Assistant Coach

Team Manager

Committee Member

Canteen

Ground/ Facilities Co-ordinator

Other

Team allocations will be made subject to the coaching team’s decision. Positions are subject to Availability Training for all players will commence in December; dates are posted on the website. Payment Received for Membership of GWSC

Club Use Only

Player:___________________________________ Date: __/__/____

Amount: $________

Rec No: _________