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Junior Registration Form 2016
Under 6/7 Junior Registration □ $180
Under 8 - U13 Junior Registration □ $250
Under 16 Junior Registration □ $200
Sibling discount □ $10 off 2nd child □ $20 off 3rd child
Personal Information □ New player □ Returning player
First name
Last name
Date of Birth / /
Gender □ Male □ Female
School
Home address
Suburb Postcode
Mobile Phone
Home Phone
Email address
Emergency Contact
Contact 1 Contact 2
Contact name
Relationship
Address(if different to above)
Phone
How did you hear about our sign on day?□ Newspaper □ School
□ Facebook □ Email from club
□ Radio □ Friend/word of mouth
□ Signage □ Other ____________________________________
We are rely on the support our generous sponsors. Are you a member of their clubs?□ Maroochy Surf Club □ Maroochy RSL
Payment Details EFTPOS □ $
CASH □ $
DIRECT DEPOSIT □ $Account Name: Maroochydore Rugby Union Club IncBSB: 124161Account Number: 21554022Use player’s name as reference
Payment Date
Notes
Get Started Voucher Number
Rugby Link Entry (FOR OFFICE USE)Date entered
Rugby ID
Payment Verified
Online registrations Complete registration form, including photography consent form Pay Registration fees by Direct Deposit with players name as reference Email completed forms to the Junior Registrar at [email protected] Training starts Thursday 18 February
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Photography and Filming Consent FormMaroochydore Rugby Union Club is seeking your consent to use photographs of you/your child for promotional purposes in marketing materials and on its website and social media page. Any images will not include players’ names.
Maroochydore Rugby Union Club will take all steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used inappropriately you should inform the Maroochydore Rugby Union Club immediately.
Any permission given is for the duration of the player’s involvement with the Club unless permission is withdrawn by a parent/caregiver in writing.
Consent Information
To be completed by Parent/Caregiver:
□I consent to the Maroochydore Rugby Union Club photographing or filming my child (Child's name: _________________________) and using these images for promotional purposes.
Print Name of Parent/Caregiver
Signature of Parent/Caregiver
Date
To be completed by Child/Young person:
□I, ___________________________________________________, consent to Maroochydore Rugby Union Club photographing or filming my involvement in sporting activities and using these images for promotional purposes.
Print Name of Child/Young Person
Signature of Child/Young Person
Date
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