Applicant Detail's
First Name		Surname
D.O.B.		Age Group	U9 U10 U11 U12 U13 U14 U15 U16 U17 U18 U19 U20 Open Mixed
Gender	Male Female	Do you play Rep Ball? Yes No
Please list your friends and who you would like to play with.
Friends		Requested Uniform #
Email
School
Contact One Details
Relationship	Mother Father Guardian Other	Other
Name		Profession
Phone (H)		Phone (M)
Phone (W)
Address
Email
Contact Two Details
Relationship	Mother Father Guardian Other	Other
Name		Profession
Phone (H)		Phone (M)
Phone (W)
Address
Medical Are there any conditions you should make the club aware about?
Details
Do you consent to medical treatment in an emergency?			No Yes
McKinnon Basketball Association - Terms and Conditions
As parent / guardian of the above named applicant, give consent to their registration with the McKinnon Basketball Association for it’s competitions and events. I understand that the applicant is bound by the rules and codes of conduct of the McKinnon Basketball Association and Basketball Victoria. I confirm that I am aware that there are certain dangers of injury in playing basketball and I agree that neither the Association it’s member Clubs nor any of its appointed Coaches or officials are liable in any way whatsoever for any injury, damage or loss of property suffered by the applicant during the course of any Association or Club activities. I understand that I will be responsible for any medical or ambulance expenses incurred by the applicant during the course of any Association or Club activities and any consequent insurance claims to the Victorian Basketball Association insurance cover. I also understand that I may be called upon to assist in team activities and that I may be asked to help with Association, and / or Club social functions and/or fund-raisers. I am aware that the Association’s Drug and Alcohol policy and the Association’s players and members code of conduct and Basketball Victoria’s codes of conduct for all participants within basketball are all listed on the Associations' web page and are all available at all venues. I also acknowledge that the Association takes photographs/videos of various activities for use on their web page and media articles. I verify that the information set out above is true and correct for all details.
I have read and understood the above Terms and Conditions.			No Yes
Brighton Wolves - Terms and Conditions
Places in Brighton Wolves teams are limited to 'first come - first served'. -I/We wish to register the above player with The Brighton Wolves Basketball Club Inc. By signing this Registration Form, I/We agree to: - Pay $200 Registration Fee (Further discounts for more children please see your treasurer). This fee covers Team Registration, Scoresheet Fee (excluding finals), training venue hire and trophies. -Pay proportion (pro rata based on the number of team members) of any forfeit fees incurred should the above players team be unable to take the court under the rules of the relevant competitions ruling body within 2 weeks of the forfeit occurring. -Pay a proportion (pro rata based on the number of team members) of additional Scoresheet Fees should the above players team becomes eligible to play in the finals. -Abide by the rules, by-laws and regulations of the Brighton Wolves Basketball Club Inc., its governing Association(s), Basketball Victoria and the respective management of any of the venues used by the Club. -Send to: The Treasurer, 14 Spink St Brighton 3186 your cheque for $200 or submit it at the Wolves Registration Night.
I have read and understood the above Terms and Conditions.			No Yes
I am above 18 years of age. If not please have your parents fill in this form.			No Yes
I agree to volunteer my services for roles such as game scoring, time keeping, team management, fund raising or any other similar roles that benefit my children’s club. (These duties will be evenly shared out between all parents and helpers)
No I won’t be able to assist but have enclosed a donation of $ to assist with the running of the club and providing such duties.

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Make sure you read and accept the Terms and Conditions above and you are above 18 years of age..