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Mixed Social Basketball 17+ - Participant Details
* PLEASE ENSURE YOU COMPLETE ALL SECTIONS
Registration Fees
Team Registration - $60
Weekly Player Fee - $8
OK
1.
Participant
Name
Age
D.O.B
*
2.
Participant Details
(Required.)
Address
City/Town
ZIP/Postal Code
Email Address
Phone Number
Medical Information
3.
Emergency Contact Information
Name
Relationship to participant
Contact Number
4.
Medical Conditions
Fainting / Dizzy Spells
Heart Condition
Diabetes
Ear disorder
Respiratory disorder
Allergic reactions (insect bites, stings or medications)
If you answered yes to any of the above please provide all additional information.
*
5.
Image Release / Permission
Mannum Leisure Centre (MLC) seeks your agreement for your child/ren to be photographed and your permission for the use of those images by MLC for promotional purposes.
This includes, for example, use in brochures, media releases, newspaper articles, websites, facebook, booklets, flyers and advertisement in print and electronic media.
I agree to my child/ren being photographed and expect no compensation for the use of my image. Mannum Leisure Centre may release, publish and otherwise make use of the images/photographs in current or future promotional material, such as those listed above.
(Required.)
Yes
No
*
6.
Declaration
I hereby release and indemnify the Mannum Leisure Centre, it's staff, coaches, scorers, timers, umpires and any volunteers from any liability whatsoever arising to myself, while participating in training, viewing or playing basketball in the Mannum Leisure Centre Mixed Social Basketball. (we recommend you seek personal alternative insurance).
(Required.)
Agree
Disagree
*
7.
Behavioral Guidelines Agreement
Our rules of behavior are underpinned by the following:
Act within the rules and spirit of the centre and sports.
Show respect and courtesy towards everyone involved and prevent discrimination and harassment.
Follow directions given by any officials.
Prioritise the safety and well-being of children and young people involved in our centre.
To encourage and support opportunities for participation in all aspects of our centre.
Acknowledge all good plays whether they are by your team or the other team.
Treat all members, players, coaches, officials, administrators, parents and spectators as you would like to be treated.
I agree to the comply with the rules of the Mannum Leisure Centre and work with other players, officials and spectators to ensure it is a safe and welcoming environment that supports the development of players and officials. I agree that if I breach any of these rules, that I will face consequences. Council is guided by the Basketball SA Tribunal by-laws and penalties.
(Required.)
Yes
No
Current Progress,
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