SDJCC Kookaburras
Sorrento Duncraig Junior Cricket Club Inc.
(ABN 99 650 286 106)
sdjcc.wa.cricket.com.au
2014/2015 REGISTRATION FORM
Registration Day: 3.15pm-5.30pm Saturday 16th August 2014
Seacrest ParkClubrooms, Seacrest Drive, Sorrento
For those who can’t attend Registration Day, complete this form in word and email to
OR print, complete and post this form with payment to SDJCC, PO Box 615 Duncraig, 6023
SECTION 1: Member contact information (*compulsory fields)
*Playerfirst name: / *Surname:*Address: / *Suburb:
*Postcode: / *Phone: / *Date of Birth:
*School attended: / *Age as of 30 June this year
*Have you played club cricket before?
Yes ☐No ☐ / If yes, please state which grade and club?
If you are a return player to this club, state which team or two players you want to continue playing for/with:
*Parent contact name / *Phone number
*Emergency contact name / *Phone number
*Email address/es
*Does your child suffer from any illness / allergy / disability? Yes ☐No ☐ / If yes, please detail
New players to the club are required to provide a copy of their birth certificate/extract for verification of date of birth. Players are eligible to play in age group according to their age as at 30th June this year. / OFFICE USE ONLY
☐
Age groups: U10, U11, U15, U16, U17 games are played on SUNDAY am.
Age groups: U12, U13, U14 games are played on SATURDAY am.
Team Allocation Policy:
Teams will be capped at a maximum of 13 players. Priority will be given to players from the previous season although players will lose the right to automatic selection if their registration is not received by 31st August. After 31st August available positions will be filled on "first in" basis.
In order to field teams we require parental assistance. Please indicate which of the following you are able to assist with.
Coach ☐ / Asst. Coach☐ / Manager☐ / Umpire☐ / Committee☐ / Sponsor☐
SECTION 2: Registration Fees, uniform purchases and payment details
Registration fee per player (Apply a $10 discount if paid in full by 31st August.)
☐$135 (paid before 31st August)
☐$145 (paid after 31st August)
Uniforms
Clothing is available to try on Registration Day. All items ordered and paid for with registration will be delivered to the teamCoach/Manager before the first game.
Club shirt ($35) Sizes:☐8 ☐10 ☐12 ☐14 ☐16 ☐S ☐M ☐L ☐XL ☐XXL
Sleeves: ☐Long Sleeve ☐3/4 Sleeve
Broad brimmed hat($15)☐55 cm ☐57 cm ☐59 cm ☐61 cm
Total payment of: $Paid by: ☐Cheque/Money order☐Bank deposit
Cheques and money orders are to be made payable to: Sorrento Duncraig Junior Cricket Club.
Sorrento Duncraig Junior Cricket Club bank details:
BSB: 016-494 Account #: 435529931 Please use player's name as reference
SECTION 3: Indemnity and Release
“Club” Means Sorrento Duncraig Junior Cricket Club Inc.
“Association” Means North West Metropolitan Cricket Association Inc.
“Child” Means child or ward (whichever is applicable)
In allowing my child to participate in the 2014/2015 cricket season
- I CONFIRM that I am a parent or legal guardian of the child and that I am responsible for organising transportation of the child to andfrom all activities associated with the competition.
- I INDEMNIFY the Association/Club, Member Club Officials including Coaches, Umpires and all associated sponsors for all liabilitycosts associated with my failure to arrange prompt collection of my child after the designated finish time of all activities.
- I ACKNOWLEDGE that there are inherent dangers associated with the program which may result in the child being injured.
- To the extent permitted by law, I agree both on behalf of the child and in my own right to ABSOLVE AND INDEMNIFY Association/Club,Member Clubs, Coaches, Umpires and all associated sponsors from any and all liability for injury, loss or damage however caused arising out of the child’s participation in the program.
- I AGREE both on behalf of the child and in my own right to RELEASE AND FOREVER DISCHARGE theAssociation/Club, Member Clubs, Coaches, Umpires and all associated sponsors from all claims that I or the child may have or mayhave had but for this release arising from the child’s participation in the program.
- I AUTHORISE registered program coordinators to arrange medical or hospital treatment (including ambulancetransportation) if I am not available to do so and I INDEMNIFY the Association/Club, Member Clubs, Coaches,Umpires and all associated sponsors for all costs associated therewith.
- I ACKNOWLEDGE that acceptance by the Club of this application for registration does not guarantee a place in a team.
- I AGREE that registration is accepted on the basis of child wearing protective equipment as laid down by the Association.
- I UNDERSTAND personal information collected by the Club is for the primary purpose of membership requirements and/or competition purposes. It will be maintained in a secure environment as per the requirements of the Privacy Act.
- I AUTHORISESorrento Duncraig Junior Cricket Club to collect (where appropriate) images of participants to use on their website/newsletters to recognise achievements and inform members about club matters.
- Completion and lodgement of this Registration Form indicates ACCEPTANCE of the Club Policies.
I have read, understood, acknowledge and agree to the above declaration.
Parent/guardiansignature: Date:
Club Contacts: Rod MacKenzie (President)
Mel Wells (Registrar)9246 7671
Postal Address: PO Box 615 DUNCRAIG WA 6023