BORONIA JUNIOR FOOTBALL CLUB Inc.
A0004878P
Club Registration Form 2015
PLAYER DETAILS:
Surname:
First Name:
DOB:
PARENT/GUARDIAN No. 1
Surname:
First Name:
Address:
Suburb:
Postcode:
Phone: Home
Mobile:
Email:
Relationship to Player:
PARENT/GUARDIAN No. 2
Surname:
First Name:
Address:
Suburb:
Postcode:
Phone: Home
Mobile:
Email:
Relationship to Player:
GAME DAY EMERGENCY CONTACT: Name: ____________________________________________
Number:
______________________________________
MEDICAL INFORMATION
Please list any current:

Medical Conditions
______________________________________________________________

Allergies
______________________________ Is an EPI-PEN required?

Sports Injuries
______________________________________________________________

Medications:
______________________________________________________________
Do you have current?

Private Health Insurance
Yes/No

Yes/No
Ambulance Membership
Yes/No
To the best of my knowledge, all information supplied is correct and I consent that this medical
information be forwarded to the team Trainer, Coach and Team Manager.
Parent/Guardian Signature: ____________________________
PLEASE READ BEFORE SIGNING:
Date: ___________________________
I hereby consent to the registration of my son/daughter with Boronia Junior Football Club within the
Eastern Football League. On completing this Registration Form and signing below, Parents/Guardians
agree to:







Abide by the Boronia Junior Football Club Guidelines, Codes of Conduct and Club Policies including
the Club Team Selection Policy.
Player behaviour at training, before, during and after games is in accordance with Boronia Junior
Football Club Guidelines, Codes of Conduct and Club Policies.
Abide by the Eastern Football League Guidelines, Bi-laws and Codes of Conduct.
Observe all Rulings made by the Boronia Junior Football Club and the Eastern Football League that
relate to me and my child.
Participate in the parent roster when requested to support the game day operation of my child’s
team.
Pay my child’s registration fees in full prior to the commencement of Round 1 unless prior
payment plan arrangements have been made with the Club Treasurer. Please arrange any
payment plans prior to Round 1. Payment Plans to be completed by Round 4.
Allow my child to participate in alternative activities during training sessions when arranged.
I confirm that I have received a copy of the Codes of Conduct in relation to players, parents and spectators.
The Club pays insurance for each player to the EFL, this insurance is limited in its cover and I understand
that the Boronia Junior Football Club and its officers and members are not liable for claims outside this
cover.
I authorise Club officials to seek whatever medical assistance is deemed necessary to provide care for my
child involved in Club activities.
Parent/Guardian Signature: ______________________________ Date: ______________________
Players Signature: __________________________________ Date: ___________________________
2015 REGISTRATION FEES:
1st Player :
2nd Players:
3+ Players:
$150.00 (Which includes the EFL Insurance fee) 10% discount if paid by 31 December 2014
$135.00 (Which includes the EFL Insurance fee) 10% discount if paid by 31 December 2014
$ 90.00 each (Which includes the EFL Insurance fee) 10% discount if paid in full by 31
December 2014
All fees MUST be paid by Round 1 of the 2015 Season
Items such as jumpers and helmets are on loan to the player from the Boronia Junior Football Club and are for use
on game day only. If jumper and/or helmet is lost and not returned after the player’s last game of the season, a fee
of $45.00 for the helmet and $75.00 for the jumper will be required to replace the item.
PAYMENT DETAILS:
TOTAL FEES DUE:
$___________________
PAYMENT METHOD:
Cash: 
Cheque: 
: EFT: to Boronia Junior Football Club
633-000 147403786 [Ref: Player(s) Surname & First Initial(s)]
NB: All players new to the Boronia Junior Football Club are required to provide a copy of their Birth Certificate.