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New Player




PLAYER DETAILS (must be 12 to 18 years)
* First Name:
* Last Name:
* Date of Birth (dd/mm/yyyy):
* Address:
* Suburb:
* Post Code:  
* State:
Height (cm): 
* Gender:
*1 Home Phone:
*2 Mobile Phone:
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:
Friend 2:
Friend 3:
Email Address:

MEDICAL HISTORY / PERMISSION
I am happy to receive information from Midnight Basketball's sponsors / partners:
Do you suffer any allergies and/or medical, physical or mental disability (eg; asthma, epilepsy, etc)? If YES, please specify, including details of medication: Details:  
Please notify us of any food allergies:
I give permission for images of me to be used by
Midnight Basketball Australia:
* 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 (For players under the age of 18)
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, shall be the sole and absolute property of Midnight Basketball 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 WOLLONGONG Midnight Basketball League. 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:
Home Phone:
Mobile Phone: 
Organisation (for community worker only):

EMERGENCY CONTACT (If different from above and for players 18 years old)
Relationship: 
First Name: 
Surname: 
Address: 
Suburb: 
PostCode:  
State: 
Home Phone:
Mobile Phone:

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