<strong>Koori</strong> <strong>netball</strong> <strong>tournament</strong>Team registration form – 25 to 26 October, 2013Condition of RegistrationMaximum of 14 players registered per teamMaximum of 3 Non-Aboriginal players per teamDrug <strong>and</strong> alcohol free eventTeams are not registered until full payment is receivedTeams are responsible for their own personal insuranceThe rules for play shall be those of Netball AustraliaEach player is required to complete the participantinformation form. For children under the age of 18 theymust have a parent/legal guardian to sign the participantinformation form before being accepted into thecompetition.Team Managers are required to attend a briefing at5:00pm on Friday 25 October in the Charlestown NetballClubhouse, when the draw will be made availableAll teams must be at the courts by 5pm on Friday25 October with play to commence at 6pm. On Saturday26 October, teams are to be at the courts by 8:00am withplay to commence at 8:30amThis year umpires will be paid at the <strong>tournament</strong>. Ifyou have an umpire that is not in a team, pleasecomplete expression of interest form enclosed.Team InformationTeam nameDivision Open Women Juniors MixedAs the team manager, I agree that all team representatives will abide by the conditions of registration list above <strong>and</strong> Code of Conductwhich is attachedTick box if you do not want to receive any future program information Team manager nameSignatureEmail AddressAddressPhonePostcodeHomeWork/MobileTeam members: Please printSurname First name Surname First name1 82 93 104 115 126 137 14Payment informationMy cheque or money order payable to ’<strong>Sport</strong> <strong>and</strong> <strong>Recreation</strong>’ is enclosed OR charge $ _________ to my credit card: Visa Mastercard Expiry dateCardholder nameSignature/For more informationcall (02) 4926 1633 or visit www.dsr.nsw.gov.au
<strong>Koori</strong> <strong>netball</strong> <strong>tournament</strong>25 to 26 October, 2013Participant informationNameAddressDate of birthPhoneHome/ /Female MalePost codeWork/MobileEmailDo you have any medical conditions, allergies or disabilities that may affect your participation in this program? Please give details.Team NameOpen women Junior MixedOptional informationTo help us serve the community it would be appreciated if you could answer the following questions:Are you of Aboriginal or Torres Strait Isl<strong>and</strong>er descent?How, where <strong>and</strong> when did you find out about this program?Yes No (for statistical purposes only)Risk waiver, Media consent <strong>and</strong> Code of Conducta) I agree to, or I agree for my child/ward to attend the Centre to undertakeall activities <strong>and</strong>/or to participate in the above program. In the case of anemergency, I authorise Office of Communities, <strong>Sport</strong> <strong>and</strong> <strong>Recreation</strong> staff,where it is impracticable to communicate with me, to arrange for me, or mychild/ward, to receive such medical or surgical treatment as may be deemednecessary. I also undertake to pay or reimburse costs which may be incurredfor medical attention, ambulance transport <strong>and</strong> drugs while I amparticipating, or my child/ward is attending the Centre/enrolled in theprogram.I underst<strong>and</strong> that although Office of Communities, <strong>Sport</strong> <strong>and</strong> <strong>Recreation</strong> <strong>and</strong>its service providers attempt to minimise any risk of personal injury withinpractical boundaries, accidents do happen <strong>and</strong> all physical activities carrythe risk of personal injury. I acknowledge that there is an inherent risk ofpersonal injury in physical activities that will be undertaken at the Centre/aspart of the program <strong>and</strong> I accept that riskb) I consent to allow <strong>NSW</strong> Government to use my name/my child’s/myward’s name <strong>and</strong> any photographs, sound <strong>and</strong> film recordings taken ofmyself/my child/my ward at this program for the promotion of the Office ofCommunities, <strong>Sport</strong> <strong>and</strong> <strong>Recreation</strong> services <strong>and</strong> initiative to the media <strong>and</strong>to the general public. (Cross out section B if you do not consent)c) I agree to, or I agree for my child/ward to abide by the condition ofparticipation <strong>and</strong> code of conductd) Tick box if you do not want to receive any future program information Full Name Self Parent Guardian (please tick)Office of Communities, <strong>Sport</strong> <strong>and</strong> <strong>Recreation</strong> at 6 Figtree Drive, SydneyOlympic Park, <strong>NSW</strong> 2127 will collect <strong>and</strong> store the information you provide toenable processing of enrolments for the program. The information will beprovided to instructors of the program <strong>and</strong> their supervisors, wherenecessary <strong>and</strong> you consent to this disclosure. If you have been asked forinformation regarding Aboriginal <strong>and</strong> Torres Strait Isl<strong>and</strong>er descent <strong>and</strong>cultural background, this information is voluntary <strong>and</strong> is being compiled forstatistical purposes only. Any information provided by you will be stored on adatabase that will only be accessed by authorised personnel <strong>and</strong> is subjectto privacy restrictions. The information will only be used for the purpose forwhich it was collected. Any information provided by you to the departmentcan be accessed by you during st<strong>and</strong>ard office hours <strong>and</strong> updated by writingto us or by contacting us on 13 13 02.Refunds <strong>and</strong> cancellationsRequests for refunds must be made within seven (7) working days prior tothe commencement of the program in which you are enrolled. All requestsmust be made in writing. All refunds are subject to an administration fee of20 per cent of the total program fee. Refunds will not be given for partialattendance, nor will make up lessons be provided. Refunds will be paid atthe completion of the program. <strong>Sport</strong> <strong>and</strong> <strong>Recreation</strong> reserves the right tocancel any program/s. Every effort will be made to give reasonable notice tothose who have enrolled when a program is cancelled. Those enrolled will begiven a full refundCondition of participation (Individual)Each player is required to complete the participant information form. Forchildren under the age of 18 they must have a parent/legal guardian, sign theparticipant information form before being accepted into the competitionDrug <strong>and</strong> Alcohol Free eventSignatureDate/ /The rules for play shall be those of Netball AustraliaPlayers are responsible for own insuranceReturn this form with payment to:<strong>Sport</strong> <strong>and</strong> <strong>Recreation</strong> Government Offices117 Bull Street, Newcastle West <strong>NSW</strong> 2302Fax: (02) 4929 4397Privacy statementFor more informationcall (02) 4926 1633 or visit www.dsr.nsw.gov.au
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