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LANGWARRIN JUNIOR FOOTBALL CLUB 2015 New Player Registration Form PO Box 4121, Langwarrin, Vic., 3910 www.langyjfc.com This form is to be used only by players who have played Auskick or at another club previously. Players who want to participate in Australian Football for the first time and hence have never played Auskick or played at any other club please register online using our online registration form. Fields marked with * are mandatory. Player Details Legal First Name:* Middle Name: Family Name: * Date of Birth: * School: * Birth Certificate Number: * Did you play Auskick: * Are you transferring from another club? * Aboriginal or Torres Strait Is: * Gender: * Male / Female School Suburb: * Yes / No Auskick Centre: Yes / No Club: Yes / No AFL Team Supported: Player Contact and Address Details Address Line 1: * Address Line 2: Suburb: * Postcode: * Phone (Home): Email: * State: * Phone (Mobile): Parent/Guardian Details Parent/Guardian 1 Firstname: * Parent/Guardian 1 Surname: * Parent/Guardian 1 Phone: Parent/Guardian 1 Email: * Parent/Guardian 2 Firstname: Parent/Guardian 2 Surname: Parent/Guardian 2 Phone: Parent/Guardian 2 Email: Parent/Guardian 1 Mobile: * Parent/Guardian 2 Mobile: Parent/Guardian Assistance Please answer the two questions below whether you are able to assist around the club. Can Help – Training/Match Day? * Yes / No Can Help – Committee/Sub Committee? * Yes / No Page 1 of 4 LANGWARRIN JUNIOR FOOTBALL CLUB 2015 New Player Registration Form PO Box 4121, Langwarrin, Vic., 3910 www.langyjfc.com Emergency Contact Details Emergency Contact Name: * Emergency Contact Number: * Emergency Contact Relationship: * Emergency Contact Number 2: Medical Information The LJFC use a system called CareMonkey that captures medical information for each player. This system is used by a number of other sporting organisations and schools. If you already use this system through another organisation the benefit is you do not need to re-­‐enter the medical information. Once registered then within a few weeks you will receive an email request to either give permission to your current medical records, existing users, or create a medical record, new users. Team Nomination LJFC will make every effort to place you in a team of your choice however there are no guarantees. If required please nominate below two current/new LJFC Players that you wish to play with or leave blank. Player Name 1: Player Name 2: Photo Use Approval By selecting "Yes" you are agreeing to have any photos taken of you to be used on LJFC social media. Photo Use Approval: * Yes / No Mailing Lists ☐ I would like to receive communications from my local club, local league, state body, the AFL and on behalf of their selected partners that may include tickets to matches, special offers and other promotions from time to time in accordance with the Australian Football Privacy Policy available at http://www.aflcommunity.com.au/privacy I would like to receive communications from my local club, local league, state body, the AFL and on behalf of their selected partners that may include tickets to matches, special offers and other promotions from time to time in accordance with the Australian Football Privacy Policy available at http://www.aflcommunity.com.au/privacy. Page 2 of 4 LANGWARRIN JUNIOR FOOTBALL CLUB 2015 New Player Registration Form PO Box 4121, Langwarrin, Vic., 3910 www.langyjfc.com Head Protection The LJFC policy is for ALL under 9 and 10 players to wear protective headwear. This is a precautionary step undertaken by the club to nurture our young players and to counter any occurrence of a head related incident. The club supplies all helmets for both age groups. Conditions of Registration Upon registering you agree to abide by the LJFC Player and Parent/Guardian & Supporter Code of Conduct. You will support the LJFC in its undertaking and encourage the LJFC to take any necessary disciplinary actions including the suspension and banning where warranted of any players, parents/guardians and/or supporters for repeated or serious breaches of these Codes of Conduct. A copy of both Codes of Conduct can be found at www.langyjfc.com under the “Code of Conduct” sub menu under the “Club” menu. The Codes of Conduct are also visible in our home change rooms. Birth Certificate A copy of the player’s birth certificate must be supplied with this registration form. AFL Vic Country Registration Form The AFL Vic Country Registration form must also be completed and supplied with this registration form. You can download a copy of the “AFL Vic Registration Form” http://www.aflvic.com.au/aflvictoriacountry/afl-­‐victoria-­‐country-­‐policies/. Page 3 of 4 LANGWARRIN JUNIOR FOOTBALL CLUB 2015 New Player Registration Form PO Box 4121, Langwarrin, Vic., 3910 www.langyjfc.com Registration Fees 1st Player = $170 2nd Player = $110 3rd & additional Players = $100 each $20 discount is applied to 1st player if paid in full on or prior to registration day Amount Owing: * $ Amount Paid:* $ Balance Owing: * $ Receipt Number (office use only): Payment Options Payment Options (please tick): * o Cash o Visa Card o Master Card o EFTPOS o EFT o Cheque Cheque Number: Fees are expected to be paid in full prior to the first game else players cannot take to the field. If you are unable to pay the full amount we are more than happy to agree a payment plan. Please discuss this with our Treasurer, Rachael Bluhm. Would you like to enter into a payment plan?* Yes / No EFT Details Are: Account Name: Langwarrin Junior Football Club BSB: 633108 (Bendigo Bank) Account #: 1088 87621 Description: <Players Name> Send email to [email protected] to confirm payment Note: LJFC reserves the right to accept or decline a registration Page 4 of 4