2015 ESSENDON ROYALS REGISTRATION FORM PLAYER

2015 ESSENDON ROYALS
REGISTRATION FORM
PLAYER INFORMATION
SURNAME:
FIRST NAME:
GENDER:
DATE OF BIRTH:
ADDRESS:
CITY:
STATE:
MOTHERS NAME:
POST CODE:
MOTHERS MOBILE:
MOTHER EMAIL:
FATHERS NAME:
FATHERS MOBILE:
FATHERS EMAIL:
FOOTBALL FEDERATION VICTORIA CODE OF BEHAVIOUR
The FFV has a code of Behaviour governing all players, parents and spectators; a copy of
which is attached.
We, the undersigned, have read the FFV Code of Behaviour and agree to abide by this code.
Failure to abide by the code may also result in suspension of Club membership
Parents are responsible for all fines incurred by their child with regard to breaking the above
Code of Behaviour.
PARENT/GAURDIAN
SIGNITURE
PARENT/GAURDIAN
SIGNITURE
MEDICAL CONSENT AND EMERGENCY INFORMATION
These details will only be used in an emergency if the Club is unable to contact the
parent/guardian.
EMERGENCY CONTACT NAME:
(OTHER THAN PARENT)
RELASHIONSHIP TO PLAYER:
PHONE NO: (H)
MOBILE:
MEDICARE NUMBER:
AMBULANCE MEMBERSHIP NO:
EXISTING MEDICAL CONDITIONS (EG ASTHMA, ALLERGIES)
** Please supply an asthma or anaphylaxis plan if appropriate **
MEDICATION DETAILS:
I agree that in the event of an emergency where the parent/guardian or emergency contact cannot
be contacted that the club may authorise a responsible adult to seek competent medical attention
on behalf of my child.
SIGNITURE:
RELASHIONSHIP TO PLAYER:
DUTIES AND VOLUNTEERS
Each family will be required to perform a number of duties for their team/s throughout the
season such as providing oranges, canteen/BBQ duties and match day officials.
We are always looking for assistance at the club – please indicate if you can assist with any
of the below:
Coaching
□
Assisting with Coaching
□
Team Management
□
Events
□
Fundraising
□
Sponsorship
□
CLUB USE ONLY
PAYMENT RECEIVED: Y / N
AMOUNT: $
PAYMENT TYPE: CASH / CHEQUE
PLAYERS PROOF OF AGE RECEIVED
YES / NO
DATE:
Any queries regarding this form please contact the club President at
[email protected]