Registration Form - Queensland Cricket
Registration Form - Queensland Cricket
Registration Form - Queensland Cricket
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Bulimba <strong>Cricket</strong> Club Incorporated<br />
(Est. 2010)<br />
Affiliated with the <strong>Queensland</strong> <strong>Cricket</strong> Association,<br />
Eastern Districts Junior <strong>Cricket</strong> Association and the<br />
Bayside East and Redlands <strong>Cricket</strong> Association (BEARS)<br />
Address Correspondence to: Bulimba <strong>Cricket</strong> Club, PO Box 36 Bulimba Qld 4171<br />
www.bulimbacricket.com.au<br />
2013 – 2014 Junior <strong>Cricket</strong> <strong>Registration</strong> <strong>Form</strong><br />
PLAYER INFORMATION:<br />
Surname: __________________________________ First Name:__________________________ Middle Name:________________<br />
Address: ________________________________________________________________________________Postcode:__________<br />
Home Phone No: ________________________ Date of Birth: / / Gender: Male ________ Female ________<br />
The player is available to play for Half or Full Season?<br />
Current Year Level: ______________<br />
PARENTS/GUARDIANS INFORMATION:<br />
School attending before Christmas:__________________________<br />
School attending after Christmas (if different): ____________________________<br />
Names: (Mother) ___________________________________________ (Father) _________________________________________<br />
Occupations: (Mother) _____________________________________ (Father) ___________________________________________<br />
Mobile Phone No(s): (Mother) __________________________________ (Father) ________________________________________<br />
Email Address: (Mother) _____________________________________(Father) __________________________________________<br />
REGISTRATION FEES:<br />
FOR U9 TO U13 PLAYERS:<br />
I wish to play Under________<br />
I wish to play with player(s) or coach__________________________________________________<br />
Full Season $190 Half Season $160<br />
I wish to purchase a club shirt $40 SIZES: 6 8 10 12 14 S M L XL<br />
PLEASE NOTE: Players are required to wear the Bulimba <strong>Cricket</strong> Club shirt for all matches and other events.<br />
Due to BEARS requirements, this fee is mandatory for those playing Under 13.<br />
FOR IN2CRICKET PLAYERS:<br />
in2CRICKET including Starter Pack $95 ~ I require a size 6 8 10 12<br />
(Starter Pack includes Backpack, Shirt, Water Bottle, Bucket Hat and Bat)<br />
OR in2CRICKET without Starter Pack $50<br />
PLEASE NOTE: in2CRICKET Players must wear the official Milo in2CRICKET hat and shirt<br />
PAYMENT: NOTE: Payment must be made before a player can be placed in a team. Available places<br />
will not be ‘held’ unless payment is made.<br />
The total amount payable is $ _______. I am paying by:<br />
Cash Cheque Direct Deposit - Bulimba <strong>Cricket</strong> Club Incorporated<br />
Suncorp BSB: 484 799<br />
Account No: 203460002<br />
Reference: Child’s Surname, First Name<br />
Please send an email to killians@optusnet.com.au once you have performed the transfer of funds to the Bulimba A/c.<br />
Major<br />
Sponsor<br />
Silver<br />
Sponsor<br />
Bronze<br />
Sponsors
Bulimba <strong>Cricket</strong> Club Incorporated<br />
(Est. 2010)<br />
Affiliated with the <strong>Queensland</strong> <strong>Cricket</strong> Association,<br />
Eastern Districts Junior <strong>Cricket</strong> Association and the<br />
Bayside East and Redlands <strong>Cricket</strong> Association (BEARS)<br />
Address Correspondence to: Bulimba <strong>Cricket</strong> Club, PO Box 36 Bulimba Qld 4171<br />
www.bulimbacricket.com.au<br />
OUR CLUB NEEDS YOUR HELP<br />
The Bulimba <strong>Cricket</strong> Club provides the development of cricketing skills, teamwork and sportsmanship for boys and girls<br />
aged 5 to 13 years of age in a positive and friendly environment. The club is run entirely on voluntary help from parents<br />
and guardians. We provide coaching, managing, umpiring & score keeping opportunities to parents and guardians<br />
along with assistance for those that require it. Your help is greatly appreciated so please indicate in the boxes below if<br />
you are able to assist us with any of the following:<br />
Team Coach Team Manager Assist at training<br />
Umpiring at matches Scorer Supervision at matches<br />
in2CRICKET Coach Assisting with in2CRICKET Committee Member<br />
AUTHORISATION:<br />
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING<br />
I, _____________________________________ am a parent or legal guardian of _____________________________ .<br />
I agree to my child applying to and being allowed to participate in the activities of the club and associations (<strong>Queensland</strong><br />
<strong>Cricket</strong>, Eastern Districts JCA & BEARS CA). In consideration of the club and associations allowing my child to take part<br />
in cricket, I acknowledge, agree and confirm the following:<br />
(a) That there are inherent risks associated with <strong>Cricket</strong> Activities (the activities) which may result in my child being<br />
injured including in a serious manner. I fully accept and agree to bear those risks in my own right and on behalf of my<br />
child.<br />
(b) To the full extent permitted by law I agree both on behalf of my child and in my own respective rights to absolve,<br />
indemnify, release and discharge the Bulimba <strong>Cricket</strong> Club and its officers, employees, representatives and agents (“the<br />
Indemnities”) from any and all liability for any injury, loss or damage to my child however caused arising out of my<br />
child’s participation in the activities, including without limitation, as a result of acts of negligence by the indemnities.<br />
(c) I consent to Bulimba <strong>Cricket</strong> Club promoting youth in cricket by publishing photographs of my child participating in<br />
the activities for the club in brochures, newsletters, on the web page of the club or by any other means as determined<br />
by the Club.<br />
(d) I authorise parent/guardian contact information be supplied to my child’s team coach and manager for the purposes<br />
of managing the team.<br />
In addition, I hereby agree and consent to the provision of the personal information regarding my child as set out in this<br />
form to the <strong>Queensland</strong> <strong>Cricket</strong> Association Limited for use by them in the course of the administration of cricket in<br />
<strong>Queensland</strong>, including registration and insurance of players.<br />
I have read, understood, acknowledge and agree to all the matters referred to in this statement, including the warning,<br />
release and indemnity.<br />
Signed______________________________________________________<br />
Date____________________________<br />
PLEASE EITHER (A) POST BOTH PAGES WITH YOUR PAYMENT TO CLUB SECRETARY, BULIMBA CRICKET<br />
CLUB, PO BOX 36, BULIMBA QLD 4171 OR (B) EMAIL BOTH PAGES ALONG WITH YOUR DIRECT DEPOSIT<br />
CONFIRMATION DETAILS TO killians@optusnet.com.au<br />
_______________________________________________________________________________________________<br />
Office Use Only –<br />
Paid - $__________ Date Payment Received - ______________<br />
Receipt Number - ____________________<br />
Major<br />
Sponsor<br />
Silver<br />
Sponsor<br />
Bronze<br />
Sponsors
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