Register - Margaret River Hockey Club

PLAYERS DETAILS

Name*

First Last

Date of Birth (dd/mm/yyyy)*

Which Team / Club did you play for in 2017?

PLAYERS CONTACT INFORMATION

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone

Mobile*

Email*

(by providing your email address you agree to receive emails from MRHC and Busselton Stadium from time to time)

Parent Guardian Information (only if player is under 18yrs of age)

Mother's Names

First Last

Contact Number

Father's Name

First Last

Contact Number (Father)

IN CASE OF EMERGENCY & MEDICAL Information (required)

Emergency Contact Name*

First Last

Relationship to Player*

Home Phone (E)

Mobile (E)*

Medical Conditions / Injuries

Allergies

I authorise the team officials to administer (to my daughter/son) the best qualified medical care available in the event of injury or accident. In the event that I cannot be contacted or any emergency situation arises and it is considered necessary for this care to include ambulance, x-rays, hospitalisation, anesthetic administration, transfusion or physiotherapy, I agree to accept the cost of these treatments and will reimburse MRHC for all expenses incurred. Whilst the utmost care will be taken, I absolve the team officials and the MRHC from all liability should any accident or injuries occur.

Do you agree with above terms?*

I Agree to above terms

WAIVER and INDEMITY
Club (means Margaret River Hockey Club MRHC), Child (means child or ward). I am aware that playing Hockey, observing hockey, learning to play Hockey and training to play Hockey and participating in any activity carried out by the Club, are activities that inherently involve some risk, and that in undertaking these activities my Child does so at his/her own risk. I am also aware that, as a condition of my child’s admission to the Club, its office bearers, officials, coaches, managers, umpires, members and / or agents are absolved from all liability arising from injury or damage however so caused. That injury or damage may arise out of membership of the Club, playing Hockey, observing Hockey, learning to play Hockey and training to play Hockey or negligence of any nature whatsoever on the part of the Club.
I do hereby acknowledge that of my own free will and desire, I have contracted with the Club for the instruction, training and playing of my child in Hockey and that I have read and understood the above waiver.

Do you agree with above Waiver and Indemity?*

I agree to the Waiver and Indemity

I give Margaret River Hockey Club permission to use photographs of my son / daughter taken during hockey club activities and be used in MRHC website / newsletter and Facebook promotional material and possibly in the local newspapers for the MRHC and the Busselton Hockey Stadium Club?

Do you give permission?*

Yes
No

And Finally....

YOUR CLUB NEEDS YOU!
Each team to raise at least $500, you can help do this through many options. Please let us know which ones you, your family, your time , your wallet are able to commit to!

Choose your fundraiser options*

Sausage Sizzle
X-Adventure (drinks table) - 21/22 April
MR Ultra Marathon (drinks table) - 5 May
Lions Shed Sales & Sausage Sizzle - 21/22 Sept
I can donate Raffle prize(s)

I'm really busy but please add $50 to my registration instead

Price: $ 50.00 Quantity:

We understand people are busy or work a lot so it might be easier to contribute your share of the funds for your team. Remember the more monies raised the lower our game fees and the more fun we have

I /My Company could be interested in sponsorship/gifts aid. Send me more details.

Send me more information on sponsorship

Team & Payment Options*

Select Payment Option

* If you are waiting on your Kids-Sport voucher, unsure of your payment amount or prefer to pay by bank transfer then please choose the PAY DEFER option.
* By completing this registration you are committing to the team registration fees minus any vouchers you receive.

Total

$ 0.00

Credit Card

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Registration Form for Players