SALISBURY INTERNATIONAL SOCCER CLUB

REGISTRATION FORM SEASON 2018

GIRLS SOCCER
Underdown Park, Nangari Rd, Salisbury Nth E: salisburyintersc@gmail.com P: 0421 089 661

PLAYER INFORMATION (please print block letters):

Surname: _______________________ Given Names: _____________________________________

Date of Birth: ____/____/____ Intended Age Group for 2018 (please circle below):

Girls: U7 U9 U11 U13 U15 U17

_______________________________________________________________________________
ARE YOU NEW TO SALISBURY INTERNATIONAL IN 2018? If so, please complete the below:
Did you play soccer in 2017? YES/NO Club___________________________Age Group/Division ___________________
Are you already registered with another FFSA club? YES/NO Club ______________________________________________
Please provide FFSA number if known ________________________

_______________________________________________________________________________
CONTACT INFORMATION & DECLERATION (For players under the age of 18):
Parent/Guardian Surname: __________________________ First Name: _______________________________________
Address: ______________________________________________________________________ Post Code: ___________
Phone: ________________ Mobile: __________________ Email: _____________________________________________
Parent/Guardian Surname: __________________________ First Name: _______________________________________
Address: ______________________________________________________________________ Post Code: ___________
Phone: ________________ Mobile: __________________ Email: _____________________________________________

I understand that 50% of the full registration payment is non-refundable and due by 31.12.17 (please tick & initial)
I understand that as the signatory I am responsible for the full payment of the registration fees (please tick & initial)
Please
Print first andticklast
herename:
if you do not wish for you or your child to be included in club promotional videos, photography or
______________________________________________________
advertisements (please tick & initial) Comments: _______________________________________________________________________________________________________
I have______________________________
Signature: read and understood the club policy and regulations Date:for ____________________________
season 2018 set out by Salisbury International S.C (please tick & initial)

Parent/Guardian Signature: __________________________ Date: ____________________________

In what areas of the club are you able to assist? Volunteering__Coaching__Team Manager__Committee__Sponsorship__

EFT DETAILS
BSB 06 5122
ACCOUNT 0090 0683
Please use an abbreviation of your daughters name and team as the reference eg.BecSu11s
SCHOOL SPORTS VOUCHER
If you wish to use the $50 school sports voucher (eligible for primary school students) please list your daughters
medicare number including if she 3/4/5 etc on the card ________________________________

Club use only: PAYMENT REQUIRED: $175 (U7s) $250 (U9s & U11s) $350 (U13s U15s, U17s)

First Payment Received? YES/NO Amount: _________________ Date: ___________ Comments: _____________________________________________________________

Full Payment Received? YES/NO Amount: _________________ Date: ____________ Comments: _____________________________________________________________