Participant Registration Form - Camden & District Netball ...

CAMDEN & DISTRICT NETBALL ASSOCIATION INCINDIVIDUAL PARTICIPANT REGISTRATION FORMClub Name1. Contact InformationInformation contained in this form must be completed in BLOCK letters.First Name:___________________ Surname:_______________ Maiden Name_______________Netball NSW Registration No:________________ Gender (please tick):Male FemaleAddress: ______________________________________________________________________City/Suburb: ________________State: _________Postcode: _________Date of Birth:_________Home Phone:_______________ Work Phone:___________________ Mobile:________________For statistical purposes only (please tick)Are you of Aboriginal or Torres Strait Islander descent? Yes NoAre you from a non-English speaking background? Yes NoDo you have a disability? Yes NoNetball NSW Mailing List (please tick)Would you like to be on the Netball NSW e-mailing list in order to receive netball news and updatesvia email?Yes If Yes, Email Address:_______________________________________________NoNetball Australia Mailing List (please tick)Would you like to be on the Netball Australia e-mailing list in order to receive netball news andupdates via email?Yes If Yes, Email Address:________________________________________________No2. Registration DetailsClub: __________________________________________________________________________Member Type: ______________________ Please enter relevant code from relevant Member Type (Section 4).Non-Player Type (please tick): Coach Umpire Scorer Manager Other (specify)___________Coach Accreditation:_______________________Umpire Accreditation:____________________Last 2 Years Playing LevelGrade: ________________________________ Year/Season:______________________________Grade: ________________________________ Year/Season:______________________________Representative History: ____________________________________________________________3. Emergency contact DetailsName: __________________________________Relationship: ______________________________________Contact Number: ___________________________Mobile: _________________________________________This document is current as at 16.01.2012

4. TableMember TypeDescriptionSenior – 18 years & overJunior – 10 to 17 yearsNetta – 8 to 9 yearsFun Net – Up to 7 yearsNon Player – all agesPWD Player – all agesPlayer Signature: Competition players 10 years & older.5. Disclaimer5.1 If Member is 18 years of age or olderBy signing this form, I agree to abide by the Association’s Constitution and By Laws, Codes of Behaviour,Member Protection Policy, Sports Injury Insurance Policy (contact the Association to view these documents). I amaware of the risks of playing netball whilst pregnant. I am aware of the risks of playing netball with a pre-existingmedical condition.MemberSignature:___________________________________________________________________________5.2 If Member is under 18 years of ageAs the Parent/Guardian signing this form on behalf of the Member, I agree to abide by the Association’sConstitution and By Laws, Codes of Behaviour, Member Protection Policy, Sports Injury Insurance Policy (contactthe Association to view these documents). I am aware of the risks of playing netball with a pre-existing medicalcondition.Parent/Guardian Signature:____________________________________________________________________Parent/Guardian Signature:____________________________________________________________________6. Netball NSW Privacy PolicyIt is the policy of the NSW Netball Association Ltd to comply with the Privacy Act. Personal information about youis only obtained from information provided by you. This data is collected by NSW District Associations affiliatedwith Netball NSW. Members can change or gain access to their personal information by contacting their DistrictAssociation or by contacting Netball NSW, PO Box 396, Lidcombe NSW 1825, Tel: 02 9951 5000, Fax: 02 99515099, email: netballnsw@netballnsw.comMember Information is collected for the following purposes:6.1 StatisticsPersonal information in an aggregated format is collated to produce statistics that is supplied to governmentagencies as required. The information is used by Netball NSW for research, developing and managing new andexisting programs, for strategic and planning purposes and for the promotion of netball in NSW. An individual’spersonal information is not identifiable or provided in this data.6.2 Administration & InformationPersonal information may be used for communicating and providing information to participants about theirmembership and/or their involvement in programs, competitions, including those of sponsors and other generalnetball activities. Any member can request not to receive mail communications that do not directly relate to theirparticipation in programs or their membership.6.3 Disclosure of Membership InformationNetball NSW may facilitate aggregate database access for Netball Australia, sponsors and other relevantinterested parties to enable these bodies the opportunity to have mail outs forwarded to members. In such casesmember’s personal contact information is not provided. Third parties, such as mailing houses, may on the signingof a confidentiality agreement, obtain a copy of aggregate data.6.4 ‘Opt In/Out’Netball NSW provides all members the opportunity to ‘opt in’ of any direct communication with the organisation.Further to this members are provided with an ‘opt out’ clause at the time of communication.Further information about the Netball NSW Membership Privacy Policy is available from your affiliatedAssociation or alternatively from Netball NSW.7. Netball NSW Refund PolicyIt is the policy of the NSW Netball Association Ltd that subsequent to receipt of Netball NSW registration fees andthe input of player registration data into the NMAS membership system refunds are not provided.NOTE: Please ensure that all details on this form are correct prior to signing & returning to your club coordinator.This document is current as at 16.01.2012