Please Print Clearly

Surname First name Date of Birth*(see note) Age as at 31/12/2015

Home address – Suburb Postcode house number, street Email address Home Phone ☐ Player’s mobile

☐ Parent 1 contact ☐ Parent 2 contact name & mobile name & mobile Please indicate by ticking one box only the preferred mobile number for all general communication. Emergency contact Birth Certificate Number* (see note) details (name and phone number) Medical conditions

What school is your Has your child played If yes – which club/team? child attending in before? 2015? ☐ Yes ☐ No Tick if your child has Year/Team Preferred playing Please tick if you can help KNC with any of the played for the e.g. 2012, 14B positions? following: following teams? (Player to complete for 11’s and up)  Sponsorship 1.  Donation  WCNR  Team coach Falconettes/Jr  Team manager Warriors  Club volunteer  WCNR Cadets  WCNR Academy  WCNR 2 Falcons/Warrior s  JNA MAC Do you hold an If Yes what is the Would you like to Umpire for Kinross?** (see note) Umpire name of the ☐ Yes ☐ No Qualification? ☐ Yes Qualification? ☐ No 2015 Kinross Registration Form Please print clearly

Parent/Player Commitment Parent and player to read and sign below  I understand that I/my child is making a commitment to play the winter season of netball for 2015  I will ensure that I/my child arrives on time for competition games, wearing the correct Kinross uniform.  I will ensure that I/my child attends regular training sessions on time and wears suitable clothing and footwear. I will notify the team Coach/Manager when my child is unable to train or play.  I understand that all players 11 year old and above must attend grading and that any queries regarding grading are to be referred to the Grading Coordinator.  I will encourage my child to play with a team spirit and to support our club and all officials with enthusiasm.  As a parent, I understand that each team must provide a timer or scorer each week and that I will be asked to perform these duties.  We understand that it may be necessary to assist in fundraising for new equipment.  I understand that it may be necessary for a photo of myself/my child to be used in club publications including newsletters, the website and certificates.  The club coaches are volunteers and are not professionally paid. All skills taught are within the individual ability and experience of the coach.  Kinross Netball Club does not accept responsibility for loss of clothing and jewellery or personal injury to players.  I understand that players use of social media can have a negative impact on the club, players, officials, parents and associates and accept that the Kinross Netball Club may take appropriate action against players who post negative or derogatory comments about any person or club associated with Kinross Netball Club, the Joondalup Netball Association or any other netball association or organisation.

*Please bring the child’s birth certificate to Registration Day as it will need to be sighted by a club official. If you are posting in your registration in advance, please include a photocopy of the birth certificate. **Please note that it is not a given that an Umpire position will be available immediately.

Player’s signature

Fees for the 2015 Winter Season are as follows*: Net Set Go 6&7 Netta 8&9 Modified 10 Junior 11,12 Juniors 13,14,15,16,17 Year of birth 2009, 2008 2007, 2006 2005 2004, 2003 2002,2001,2000,1999,1998 Total fees $160 $260 $285 $285 $305

Parent signature Date

Are you using Kidsport Vouchers? ☐ Yes ☐ No

*Please check the Kinross Club website for Kidsport details. Health Care & Pension Card Holders and other parents may be eligible for a KidSport payment of up to $200 towards fees.

PAYMENT DETAILS You may pay using Cheque or Cash on Registration Day or by direct bank deposit or transfer prior to Registration Day.

Please make cheques payable to Kinross Netball Club Inc.

If making a direct deposit or bank transfer please use the following details: *If you are registering more than one child, please do a separate transaction per child.

Account name: Kinross Netball Club Inc BSB: 086275 Account number: 79 655 4649 Reference: Please write the first 5 letters of the player’s surname followed by the player’s age e.g. GROSS13. Please print a copy of the payment receipt and bring to registration day. 2015 Kinross Registration Form Please print clearly

Kinross Netball Club Use Only:

DOB Full Fees Net Set Go 6 2009 $160 Net Set Go 7 2008 $160 Netta 8 2007 $260 Netta 9 2006 $260 Modified10 2005 $285 Junior 11 2004 $285 Junior 12 2003 $285 Junior 13 2002 $305 2001 2000 Junior 17U $305 1999 1998

Receipt Number

Birth certificate number

Signature