Registration Form – Season 2014

First Name: / Surname:
Address: / Post Code:
Date of Birth: / Age this year:
Home Phone Number: / Mobile:
Email : / WA NETBALL MEMBERSHIP #:

PARENTS’/GUARDIAN DETAILS (if under 18 yrs):

Mother’s Name: / Mobile Number:
Father’s Name: / Mobile Number:

PLAYER’S NETBALL HISTORY:

Club last played with: / Year last played: / Grade played:
Association you played (other please specify) :
Based on skills, what level of player would you be? / Beginner: / Intermediate: / Advanced:
What grade do you wish to play in this season?
Please note, this is not guaranteed until after grading) / Lowest:
(Social) / Middle:
(Social competitive) / Highest:
(Competitive)
What is your preferred 3 playing positions? / 1st) / 2nd) / 3rd)
Do you have any special requests? ie. have a friend to wish to play with?
(Please note, this is not a guarantee but we will try to accommodate)

CLUB INVOLVEMENT:The Club requires assistance from many volunteers – please contribute to your club.

Please tick any of the following player or family members are prepared to assist with:
Coach / Apprentice Coach / Team Manager / Assist generally during training nights / Umpiring / Scoring / Timing / Committee / Fundraising or Social / Sponsorship
PLAYER
FAMILY
Able to provide sponsorship support? YES NO
SPONSORSHIP SUPPORT Details:
SEEKING EXPRESSIONS OF INTEREST: Preferred Training Day afternoon for ‘NettaSetGo Comp’ players:

FEES:

COMP: / Based on Age Group at 31 Dec this year. / Various Components of Fee Total / TOTAL
SNA / Regional / NetballWA
(includes membership, insurance, grounds fees) / Liberty Netball Club
(inc. equipment, trophies & admin costs) / Umpiring
(includes paid umpire for the 16x week season)
SENIORS / Senior - 18 yrs & up / $153 / $27 / $60 / $240
Junior- Under 18yrs (13-17yrs) / $125 / $212
NetSetGo COMPETITION / (Formally known as ‘Netta’)
Under 10yrs (7-10) / $106 / $6 / $32 / $144

Do you require a Uniform? Yes / No If yes, please indicate size. (Refer to Uniform Order Form).

UNIFORM / DRESS SIZE: / BIKE PANTS SIZE: / OTHER / TRAINING TOP SIZE: / JACKET SIZE: / TRACK PANTS SIZE:
PRICE / $ / $ / $ / $ / $

TOTAL PAYABLE:

FEES
UNIFORM
TOTAL TO BE PAID : / $
Please write deposit to be paid here
OUTSTANDING DUE:
Registration Page 1 of 2

PHOTOS

I agree to Liberty Netball club using netball related photos of myself and/or my child in printed and electronic media for the purpose of promoting the club. I understand that any images used will be appropriate in nature and suitable for publication. I agree to the player’s name being used to identify participation when necessary.

MEDICAL HISTORY:

This information will be kept strictly confidential and only outlined to the Executive Committee and Coach of the player.

Do you have any current medical conditions? (If yes please outline medical condition)

Yes / No / Please provide details, including treatment and medication requirements:
In the event of an emergency would you allow a member of the Club to take the player to
nearest hospital / doctor for medical attention? / Yes / No

CONTACT IN AN EMERGENCY:

Name: / RELATIONSHIP:
Home Phone Number: / Work Number: / Mobile Number:

ACCEPTANCE of REGISTRATION INFORMATION:

I accept that netball is a vigorous sport, and that injuries can occur as a result of my participation.

I agree to play for the Club entirely at my own risk. All medical costs will be my financial responsibility. I understand the Club does not have insurance for players.

In the event of piercing or other jewellery not being removed prior to a match or training, I take full responsibility for any injury or loss to either another or myself.

I agree to abide by the rules of the club and will support the coaches and Club officials.

I accept that I will be graded in a team according to the ability that I demonstrate at selections.

Your Registration Fee is non-refundable, full fees are to be finalised by the due date as specified or by arrangement of the 1st game of Round 1.

I hereby give do not give consent for myname and likeness to be posted on the Liberty Netball Club official website and for my name and likeness to be used in Liberty Topics and or any media articles where appropriate.

Signature (Member): / Date:

I agree to abide by the rules of the club and will support the coaches and Club officials.

I accept that my child will be graded in a team according to the ability demonstrated at Selections.

Your Registration Fee is Non Refundable, full fees are to be finalised by the 1st game of Round 1.

I am happy for the Club to use appropriate photos of my child on the clubs website and in printed materials.

Signature (parent/guardian if member under 18): / Date:
Registration Page 1 of 2

REGISTRATION:

The completed registration Form (two pages above) and Fees (Payment Options below) should be returned to: r toThe Registrar Liberty Netball, PO Box 14, BULLCREEK WA 6149
Payment Options:
  1. Cash, money orders or cheques payable to a ‘Liberty Netball Club’ at the club rooms or via post:
Liberty Netball Club
PO Box 14
BULLCREEK WA 6149 /
  1. Direct Electronic Transfer to:
Liberty Netball Club
BSB: 086 138
Account Number: 126876542
(Insert players name as reference). Email with receipt number once completed
PAYMENT OF FEES DUE:
The 1st instalment (a deposit ie.$140) of fees MUST BE PAID on registration for each playing member. Fees are to be PAID IN FULL by29thof February. If for any reason you will be unable to pay the full amount by theFriday 29th of February, please call or speak to our club Treasurer, Daniele ayment plans may be arranged). Liberty’s formal team submission/selectionwill be allocated 7th March for paid members & payment to SNA will be 12th March.
Please note: Players who are not financial with the club by the 29th of Marchwill be ineligible to play in graded team & further games until fees have been finalised. This will be enforced due to the fact that unless full fees have been paid players are not covered by SNA’s Insurance Policy.

FUNDRAISING:

As a not for profit organisation we rely heavily on fundraising and sponsorship. All players are required are encouraged to participate in all fundraising activities arranged by the Club.

UMPIRING:

If you would like to register to umpire for the Club (either senior or junior games) on a paid basis, please see Alyce Matulovich our Umpire Coordinator.

PRIVACY POLICY

Information that you provide in this Registration Form is given to club officials, including the Committee, team managers, coaches and other officials, for the purpose of carrying out club activities. By providing this information you give consent for the club to use the information in accordance with the Club’s Privacy Policy (can be downloaded from the club’s website).

REFUNDS:

Refunds granted before grading commences are refunded in full. However, if a person withdraws during or after grading then no refund is payable except in exceptional circumstances. All applications for refunds must be made in writing to the Executive Committee for their consideration. All fees are to be paid by the first game of round one, unless a payment plan has been arranged with the Treasurer.

CONTACTS: EMAIL: WEBSITE:

JOIN OUR FACEBOOK PAGE:

COMMITTEE 2014– We’re now Recruiting positions for 2014!!!

President: / Tania Lavey / 0431 718 839 /
Vice-President:
Vice-President: / Latoya Bolton / 0416 669 512 /
Treasurer: / Daniele Wottle /
Secretary: / Lizzie Hoyle
Umpire Coordinator: / Alyce Matulovich / 0412 967 044 /
Equipment Coordinator: / Dee Hutchinson / 0402 720 061
Uniform Coordinator: / Dee Hutchinson
Registrar: / Donna Bracken
Grading Coordinator: / Latoya Bolton; Dee Hutchinson; Tania Lavey; Alyce Matulovich
Social Coordinator:
Sponsorship Coordinator: / Ashlee McCarthy & Mikayla Prescott
Fundraising Coordinator: / Jemma Graham
Coaching Coordinator:
Website Coordinator: / Lizzie Hoyle
Club Historian / Statistician: / Lizzie Hoyle
Netta Coordinator: / Alyce Matulovich; Latoya Bolton
Additional Committee members:
Player Information Page 1 of 1