Pinecones Netball Club Inc.

ABN 70697895918

4 Myrtle Place

Albany Creek 4035

REGISTRATION FORM 2015 / PLEASE PRINT CLEARLY / NQ ID.
1. Player 1 Details / Player 2 Details
Surname
Christian Names
Date of Birth
Yes/No Date Sighted
New Players Only - Birth Certificate Sighted
Street Address
Suburb & Post Code
Telephone (Mobile)
Telephone (Home)
Email Address

Yes No
Aboriginal or Torres Strait Islander
Do you have a disability – please identify

Yes No
Are you from a culturally or linguistic diverse background? / Surname
Christian Names
Date of Birth
Yes/No Date Sighted
New Players Only - Birth Certificate Sighted
Street Address
Suburb & Post Code
Telephone (Mobile)
Telephone (Home)
Email Address

Yes No
Aboriginal or Torres Strait Islander
Do you have a disability – please identify

Yes No
Are you from a culturally or linguistic diverse background?
Do you suffer from any medical condition? / Do you suffer from any medical condition?
2. PARENT/GUARDIAN INFORMATION (for all players under 18 years of age)
Full Name
Address
Phone
Email
Relationship / Full Name
Address
Phone
Email
Relationship
3. MEDIA PERMISSION
I approve for the child/children/player to be photographed or electronically recorded for Pinecones Netball Club Inc.and used on the club’s website andnewsletter. I also approve for these to be used for public relations and or media releases. Wherever possible parents/players will be contacted prior to any formal media release.

Yes No
4. Season last played
Winter/Summer (please circle) / Year
Club / Association
Grade Last Played
5. Position Nominating for (mandatory if playing 10 and above) / 1. / 2.
6. Do you wish to participate in any of the following / Player (please tick) / Parent (please tick)
Coach
Assistant Coach
Umpire
Manage
Assist with set up of courts
First Aid Officer for Team
7. Fees Registration & Uniforms
Player Registration
8&9 years in 2015 - $225 / 10 years in 2015 - $225 / 2nd child take $5 off / Sub Total $
11 years to adults $235 / 2nd child take $5 off / 3rd child take $10 off / Sub Total $
Uniforms
Dress $65 / Visor $10 / Other / Sub Total $
Receipt No / Date / Total Cost / $
8. Refund Policy
I hereby accept if I/my child withdraws, prior to the start of the season I will lose $35 to offset any administration work undertaken by Pinecones Netball Club Incorporation.
Netball Queensland will not refund any fees once a registered player takes part in any form of club or association activity e.g. grading, game or function from 1 January 2015.
All fees are forfeited if I/my child withdraws after the season has commenced.
I hereby accept if I/my child withdraws after the season commences I forfeit all fees paid.
9. Conditions of Acceptance
UNLESS PRIOR ARRANGEMENT IS MADE WITH THE CLUB EXECUTIVE, ANY UNFINANACIAL PLAYER WILL BE INELIGABLE TO PLAY AND THIS MAY JEOPARDISE THE TEAM.
I wish to register as a member of Pinecones Netball Club Inc. I agree to accept and be bound by the Club and the Pine Rivers Netball Association Rules and Regulations, and I accept the decisions of the Club’s Executive and Grading Committees.
I agree to pay the required fees, in full by the due date, except in special circumstances agreed to by the Club Executive. I agree that non-payment of such fees could result in not being allowed to take the court.
Please complete and submit at either pre-season training; sign-on at PRNA courts between 9am and 5pm on 31 January or send to the address on the front of the application form. Full payment should be given with application either in cheque, cash or EFT to BSB No 124-185 Account No 90639120.
Player/s SignatureParent/Guardian SignatureDate

OFFICE USE ONLY

Summary of Fees
Player Fees Owing / Total: $
Uniform Fees Owing / Total: $
Total Amount Owing / Total: $
Part Payments Received / Total: $
Balance Owing / Total: $
Bank Details
Bank: / Bank of Queensland
Branch / North Lakes
BSB No: / 124-185
Account No. / 90639120
Reference / Players full name