Player 1 Details * *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Player 2 Details

First Name

Last Name

Date of Birth

MM

DD

YYYY

Player 3 Details

First Name

Last Name

Date of Birth

MM

DD

YYYY

Player and/or Parent Contact Information *

First Name

Last Name

Phone

(###)

###

####

Emergency Contact Person *

First Name

Last Name

Phone

(###)

###

####

Volunteers are an integral part of a successful community sports club. Are you able to volunteer? *

Coach

Coaching Assistant

Game Day Roles eg Linesperson

Team Manager

Canteen

Committee

Do you provide permission for any images taken of you to be used for promotional purposes including social media *

Yes

No

Conditions of Participation *

Parent(s) and player(s) acknowledge Healesville Soccer Club's Code of Conduct and agree to observe and obey these Codes and all rulings made by the Club that relate to me. I understand that there are fees associated with participation and will pay them before or by the expected due date.

I agree to adhere

Parent/Guardian (Junior registrations should be completed with the permission of the players legal guardian). Please complete these details. *

First Name

Last Name