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New Player




PLAYER DETAILS (must be 12 to 18 years)
* First Name:
* Last Name:
* Date of Birth (dd/mm/yyyy):
Height (cm): 
* Gender:
* Address:
* Suburb:
* Postcode: 
* State:
* Contact Phone 1:
Contact Phone 2:
Email Address:
School:
Aboriginal or Torres Strait Islander: 

You can nominate up to 3 friends you would like to have in your team and we will do our best to accommodate at least one, but cannot promise. (A separate registration form is required for every player)
Friend 1 (first & last name):
Friend 2 (first & last name):
Friend 3 (first & last name):

MEDICAL HISTORY / PERMISSION
I give permission for images of me to be used by
Midnight Basketball Australia:
I am happy to receive information from Midnight Basketball's partners:
* Do you suffer from any food allergies? If YES, please complete details:Details:  
* Do you suffer any other allergies and/or medical, physical or mental disability (eg; asthma, epilepsy, etc)? If YES, please specify, including details of medication:Details:  
* Is there any reason, including those above, which might prevent you from participating in this competition:  
* I understand, acknowledge and agree to be bound by the terms of privacy notice & disclaimer (click here): 

PARENT / CARER CONSENT
I give permission for images of this player to be used by
Midnight Basketball Australia #:
# I understand that all materials produced by, or in conjunction with Midnight Basketball Australia, shall be the sole and absolute property of Midnight Basketball Australia who may use (my) image/s in all forms of advertising material in any medium or manner it may decide for an indefinite period.
* I personally consent to the applicant registering / participating in the MARRICKVILLE Midnight Basketball Competition. I confirm that I have read and understood the privacy notice and disclaimer (click here):
* Relationship #:
# Community worker can only sign if a parent/guardian is unavailable. You know the applicant and believe it is in his/her best interests to participate.
* First Name:
* Surname:
* Address:
* Suburb:
* Postcode: 
* State:
* Contact Phone 1: 
Contact Phone 2:
Organisation (for community worker only):

EMERGENCY CONTACT
* Relationship: 
* First Name: 
* Surname: 
* Address: 
* Suburb: 
* Postcode:  
* State: 
* Contact Phone 1:
Contact Phone 2:

PLAYER CONSENT
* Please check the box if you have read all the terms and conditions and agree with them.