Player Name:
Address:
 
Male/Female:
Age group:
Email:
Phone: Home Mobile
  Fax    
School: Year:
Emergency Contact Name:
Emergency Contact Phone:
Medical Info:
Previous Club:
No. of seasons played hockey:
Played in a rep team:
 
Junior and secondary only
 
DOB:
Parent/Guardian names:
Parent Help: Without perental involvement we cannot function effeciently as a junior club. Please consider how you can help your child by helping the club. Advice and support will be given, particulary for the coaching role. Tick one or more. Thank you.
 
Seniors and Parents we would appreciate your input with any of the following. Tick one or more.
 
Coach Manager  
Committee Umpiring  
Fundraising      
Willing to help eg. Gear, sponsoship, co-ordinating teams, fundraising co-ordinator for team / club assisting coach, manager, collecting uniforms, uniform responsibility, transport co-ordinator etc
Other:
 

The fees for this season are as listed below:
 

Junior: $130

Secondary School: $290

Senior: $380

Umpire levy: $10 (optional*)

* = Umpire levy is a senior/secondary player requirement only, and if you do not agree to pay this then you are agreeing to umpire at least one game for the club
 

By ticking here you agree to pay your applicable fees