2018 FOOTBALL SEASON REGISTRATION

Registration queries & forms to be sent to Danny Forbes
E:
T: 0412 793 206

Note: For Auskick registrations please visit our website:

Please complete one form per child.

Fees

Fees for the 2018 season:

1st and subsequent children registered prior to 31stDecember 2017 / $190
1st child registered on or after 1stJanuary 2018 / $220
Subsequent children registered on or after 1stJanuary 2018 / $190
Under 11s incentive programme for all new under 11s players / $110

Registration Type

Mixed Team / Under 9s
☐ / Under 10s
☐ / Under 11s
☐ / Under 12s
☐
Girls’ Football / Under 14s
☐ / Under 16s
☐

Child’s Basic Information

Please note that all information requested is required by Sporting Pulse (the AFL’s registration system), to complete your registration. Please fill in as best you can. We’re sorry!

First name
Surname
Date of Birth / Click or tap to enter a date. /
Gender /

Home address line 1
Home address line 2
Suburb
Postcode
Home Phone
Mobile (of parent/guardian)
Email (of parent/guardian)
School name
School suburb
School Grade in 2018 / Choose an item. /
Is the child of aboriginal and/or Torres Strait Islander origin? /
Country of Birth
Were either of the child’s parents born overseas? /
Mother’s country of Birth
Father’s Country of Birth
Do you approve use of any images of this child taken at club training or matches for use for marketing, communications or promotional purposes such as newsletters, social media and advertising? /
Which AFL team does this child support?
How many AFL home and away matches did this child attend during the 2017 season?

Parent/guardian Information

First name
Surname
Phone number
Mobile number
Email
Is the parent or guardian interested in volunteering at the club during 2018? /
If interested in volunteering does the parent or guardian hold a working with children check? /

Emergency Contacts

Emergency Contact First name
Emergency Contact Surname
Child’s relationship to the emergency contact
Emergency contact phone
Child’s Ambulance Membership Number
Child’s Private Health Insurer
Child’s Private health Insurance Number
Child’s Medicare Number
Does the child have any medical conditions?
Does the child have any allergies?
Medical notes:

Payment

EFT Payment

If paying via EFT please use these details: / (please include players name)
Mordialloc Redbacks Junior Footy
BSB 633 000
Account157 870 627

Credit Card Payment

Select Card Type / VisaAmerican ExpressMastercard
Name on Card
Card Number
Expiry Date
CSC
Payment Amount
Signed