player registration form 2005 - Hampton Junior Soccer Club ...

PLAYER REGISTRATION FORM 2005
PLAYER INFORMATION
Surname:……………..……………………. First Name:…………………..…………………
Email Address (preferred method of communication): ……………….……………..………….……
Address:……………………………………………………………………………………………
………………………………………………………Postcode……………………
Phone Number(s) AH:…………………… Bus Hours:……………………………
Mobile:…………………………………………
Date of Birth………../……../19…………. (proof of age required)
Juniors (Under 11 – 13 only) must also attach 2 passport style photographs with name and date
of birth on back for VSF Player Identification Card
** note : Under 7,8,9 and 10’s : DO NOT need to provide the above mentioned photos **
Last year’s HJSC team (existing members only)………………………..………….
Preferred HJSC Team for 2004……………………….(HJSC will attempt to accommodate where possible).
Mother’s Name:………………………………………….
Phone (if other than above)………………………………….
Father’s Name :……..……………………………………
Phone
…………………………
MEDICAL CONSENT AGREEMENT-EMERGENCY INFORMATION
These details to be used in any emergency only if the Club is unable to contact parent/guardian
Emergency Contact :………………………………. Relationship to Member………………
(other than mother or father)
Phone No: (H)………………………..
Mobile ………………………………..
Medicare Number:……………………… Ambulance Membership Nbr:…………………
Existing medical conditions (e.g,. asthma, allergies.)
………………………………………………………………………………………………….
Medication details (if applic)……………………………………………………………….
I agree that in the event of an emergency where neither parent/guardian nor emergency contact
cannot be contact that the club may authorise a responsible adult (such as the coach may seek
competent medical attention on behalf of my child
Signature……………………………….Relationship to child…………………………….

VICTORIAN SOCCER FEDERATION CODE OF CONDUCT
The VSF has a Code of Conduct governing all players, parents and officials, a copy
of which is attached.. It is a condition of registration that you sign this agreement.
I have read the VSF Code of Conduct and agree to abide and ensure that my child
abides by the VSF code of conduct
Signature……………………………………
Name …………………………………
PAYMENT DETAILS
All registrations to be submitted with payment (cheques made payable to Hampton
Junior Soccer Club) on either of the registration day (27Feb 2005) or by mail to
HJSC
PO Box 1154, Hampton North 3188
Type First Child Second and subsequent Childred
Goal Kick (5-10 yrs) $80 $80
Sub-Juniors (Under7 – 10) $130 $110
Juniors (Under 11-14) $170 $150
If HJSC is unable to accommodate your child a full refund will be made.
MEMBER DETAILS
In order to have your details (name and phone number) included in the team list we
required the following to be completed.
We do/do not permit HJSC to include our telephone number and name in the team
membership list.
Signature…………………………………
DUTIES/VOLUNTEERS
Each family will be required to perform a number of duties throughout the season such a
providing oranges, washing uniforms and canteen duties. In addition to this we require
volunteers to assist in the running of the canteen, club and teams.
A team manager is required in addition to the coach to act as a liaison between the
coach and players and their families. This position is an important and rewarding one
and we urge you to consider offering your services.