East Fremantle District MELVILLE Junior Football Club					“The Hawks”
		2008 REGISTRATION FORM
PLEASE BRING THIS FORM WITH YOU ON REGISTRATION DAY “This form MUST be signed on the back by parent or guardian” Please Circle Age Group: Auskick 9’s 10’s 11’s 12’s 13’s 14’s 15’s 16’s 17’s
Were you registered with another club before? YES NO
If Yes, Please state Club and last Year played: _____________________________________________ Name of school you will attend in 2008: _____________________________________Year__________
NAME:	_______________________________________________________________________
ADDRESS:	______________________________________________________________________
	_______________________________________________________________________
DOB:	____________________		B/CERT NUMBER:		________________________
PHONE:	____________________		MALE FEMALE		(Please Circle)
EMAIL:	_______________________________________________________________________
PARENT / GUARDIAN INFORMATION
NAME:	_______________________________________________________________________
ADDRESS:	_______________________________________________________________________
	_______________________________________________________________________
Parental assistance is essential for the successful running of our club. Assistance will be required, on a roster basis, for duties each week that are relevant to your child’s age group. These duties include: goal umpires, time keeper, scorer, canteen, runner , water carrier, first aid & interchange steward
Please circle if you can assist in other areas: Coaching Administration/team manager Social Committee Fund Raising
Does your child suffer from any allergy, medical condition, or is he/she allergic to any medication?								YES NO
DETAILS:	______________________________________________________________________
	______________________________________________________________________
IN CASE OF EMERGENCY, PLEASE CONTACT:
NAME:	_______________________			PHONE: (Mobile pref.)		_____________________
In case of emergency, do you authorize the junior club to arrange any necessary treatment for your child, where prior notification has not been possible? YES NO

Parental / Guardian Agreement: By registering the above mentioned player with the Melville Junior Football Club (MJFC) for the 2008 season I/we hereby give permission for the MJFC to use images of the player for use in team photo’s, press releases, photos on official internet sites, videos of games, etc. SIGNED:___________________________ DATED:______________________________________ PARENT /GUARDIAN MELVILLE JUNIOR FOOTBALL CLUB CONTACT For further information please contact the club Registrar Jenny Cutts Mobile: 0414 912 914 Email: jcutts@iprimus.com.au
PRIVACY POLICY Personal information collected by Melville Junior Football Club is for the primary purpose of membership requirements and/or competition purposes. It will not be released for any form of commercial gain and will be maintained in a secure environment as per the requirements of the Privacy Act. Completion and lodgment of this Registration Form indicates acceptance of the Club’s policy.
WAIVER AND INDEMNITY ‘Football’ - Means Australian Rules Football ‘Club’ - Means Melville Junior Football Club ‘League’ Means East Fremantle District Football Development Council Inc. ‘Child’ Means child or ward (whichever is applicable) I am aware that playing Football, observing Football, learning to play Football and training to play Football, and participating in any activity carried out by the Club, are activities that inherently involve risk, and that in undertaking these activities my child does so at his/her own risk. I am also aware that, as a condition of my child’s admission to membership of the Club, its office bearers, officials, coaches, managers, umpires, members, and/or agents are absolved from all liability arising from injury or damage howsoever caused. That injury or damage may arise out of membership of the Club, playing Football, observing Football, learning to play Football and training to play Football, or negligence of any nature whatsoever on the part of the Club or League, their representatives, office bearers, officials, coaches, managers, umpires, members, and/or agents. I understand and agree that nothing in this agreement purports to exclude any liability that may be owed by the Club or the League and their representatives pursuant to the provisions of any relevant Statutory Act/s covering these activities. To the extent that any part of this agreement may contravene any of the Statutory Act/s I agree that part of the agreement may be severed and rendered void but the rest of the agreement will remain valid and continue to have effect. I............................................................................of...........................................................do hereby acknowledge that of my own free will and desire, I have contracted with the Club for the instruction, training and playing of my child in Football and that I have read and understood the above waiver.
______________________________________________________________________		___________________________
Signature – Parent/Guardian		Date
OFFICE USE ONLY
FEES $___________	RECEIPT NO: _________ FEES PAID WITH OTHER AGE GROUP_____________________
Signed Club Official:	_______________________________________________________________