Berwickflames.com

FAMILY REGISTRATION FORM
SUMMER 2011/2012
All information must be PRINTED CLEARLY, completed in full and submitted to the relevant BFBC
representatives on duty during Registration Day.
FAMILY Name:
______________________________________________ Address:
________________________________________________________ _______________________________________ P/Code: __________
( ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ Family Email:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ @ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(ALL CONTACT/CORRESPONDENCE FROM THE CLUB TO PLAYERS AND FAMILIES, WILL BE MADE VIA EMAIL AND POSTING
ON OUR WEBSITETHEREFORE EVERY FAMILY MUST PROVIDE AN EMAIL ADDRESS ON THEIR
REGISTRATION FORM.
PARENT/GUARDIAN/SENIOR PLAYER DETAILS:
Mother’s Name:
__________________________________ Mobile No: _______________________
Father’s Name:
__________________________________ Mobile No: _______________________
Adult’s Name:
__________________________________ Mobile No: _______________________
Please indicate who you would like to be the main contact: ( ) Mother I, (print name) _____________________________________ as parent/guardian, permit the fol owing child/children to register for Summer Season 2011/2012 with the Berwick Flames Basketbal Club. I confirm that the children stated below are not registered with another club, or if so, they have had clearance papers completed by the relevant bodies.
Player 1: Please tick: ( ) After School Team
_____________________________________________ ____________ Date of Birth: ________________ ______________________________ Jersey Number: ____________ _________________________________________________________ _________________________________________________________ Does the child require medication during game play: i.e.: Ventolin Inhaler ____________ BFBC Team: ___________________________ Jersey Number: _____ BFBC Team: ___________________________ Jersey Number: _____ BFBC Team: ___________________________ Jersey Number: _____ FAMILY REGISTRATION FORM
ummer 2011/2012 Season (cont.)
Player 2: Please tick: ( ) After School Team
_____________________________________________ ____________ Date of Birth: ________________ ______________________________ Jersey Number: ____________ _________________________________________________________ _________________________________________________________ Does the child require medication during game play: i.e.: Ventolin Inhaler ____________ BFBC Team: ___________________________ Jersey Number: _____ BFBC Team: ___________________________ Jersey Number: _____ BFBC Team: ___________________________ Jersey Number: _____ ________________________________________________________________________________________ Player 3: Please tick: ( ) After School Team
_____________________________________________ ____________ Date of Birth: ________________ ______________________________ Jersey Number: ____________ _________________________________________________________ _________________________________________________________ Does the child require medication during game play: i.e.: Ventolin Inhaler ____________ BFBC Team: ___________________________ Jersey Number: _____ BFBC Team: ___________________________ Jersey Number: _____ BFBC Team: ___________________________ Jersey Number: _____ FAMILY REGISTRATION FORM
– Summer 2011/2012 Season (cont.)
Player 4: Please tick: ( ) After School Team
_____________________________________________ ____________ Date of Birth: ________________ ______________________________ Jersey Number: ____________ _________________________________________________________ _________________________________________________________ Does the child require medication during game play: i.e.: Ventolin Inhaler ____________ BFBC Team: ___________________________ Jersey Number: _____ BFBC Team: ___________________________ Jersey Number: _____ BFBC Team: ___________________________ Jersey Number: _____ You have now completed your family’s registration for Berwick Flames
Basketball Club’s Summer 2011/2012 Season.
Please read and complete carefully the next page as your weekly
payments must be strictly adhered to.
All fees not finalised for the Summer 2011/2012 Season as per your
payment arrangement by the week ending 28th October 2011, all players
within your family will be declared outstanding by the committee and they
will be unable to take to the court until all fees are paid.
Total Family Fee (Including Discount): $ ___________
Additional Game Fee Due: $ ___________
Total Due: $ ___________
Delete whichever of the following is not applicable.
I, (Print Name) _______________________________________________________Have
read and accept the BFBC Summer Season document stating Registration Fee
requirements and hereby accept full responsibility for payment of the above noted players
and agree to the WEEKLY payment schedule stipulated by the club. If I fail to pay the
prescribed weekly amounts on the dates stated, I understand that my child/children wil not
be permitted to play games after 28th October 2011. Both I and my children have read and
accept the Parents and Players Code of Conduct and agree to abide by them at al times.
I,(Print Name)_________________________________________________________Have
read and accept the BFBC Summer Season document stating Registration Fee
requirements and hereby accept full responsibility for payment of the above noted players
and agree to Make Full Payment of fees at registration. Therefore no additional weekly
payments wil be required. Both I and my children have read and accept the Parents and
Players Code of Conduct and agree to abide by them at all times.

Parent/Guardian: ____________________________
BFBC Rep: _________________________________
(Signature)
(Signature)
Print Name: ___________________________
Print Name: __________________________
Date Signed: _____/_____/2011
Date Signed: _____/_____/2011
Payment Made At Registration: $ _________ ( ) EFTPOS ( ) Net Tfr ( ) Cheque ( ) Cash

Source: http://berwickflames.com/Joomla/images/stories/familyreg2011.pdf