Ground Breakers Term 1

Ground Breakers Term 1

Ground Breakers Mixed Gender: Tuesday - Ground Breakers Girls Only: Wednesday
Player Details
Name *

First Name Last Name
Gender *
Date of Birth *

Day Month Year
Date
Email *
example@example.com
Medical Information
Does your child suffer from any of the following?

Asthma Epilepsy Diabete Allergies Other
Other: Please State
Does your child use regular medication? *

Yes No
If "Yes" please provide details
If you have selected "Yes" to either Asthma or Allergies you must submit an Asthma or Allergy Management Plan. Players will not be permitted to play until this information has been provided.

Cancel of
Consent to Medical Treatment
I authorise officials, coaches and team managers to obtain for my child any necessary medical treatment by appropriate medical practitioners in the event of injury in my absence and where impractical to communicate with me. Should it be necessary to call an ambulance for my child, I accept full responsibility for any cost incurred.
Parent/Guardian Signature *

Clear
Emergency Contact Details
Contact 1 Name *

First Name Last Name
Contact 1 Mobile Number *
Contact 2 Name *

First Name Last Name
Contact 2 Mobile Number *
Terms and Conditions

Available via our website: https://www.morningtonbasketball.com.au/wp-content/uploads/2020/12/Terms-and-Conditions-of-registration-website-11-Dec-20-1.pdf
I have read and agree to the Terms and Conditions *

Yes

My Products

Ground Breakers (Early Bird) - Tuesday 4:00pm-4:55pm at Mornington Basketball Stadium

$ 110.00 AUD Quantity

Ground Breakers (Early Bird) - Wednesday (Girls Only) 4:00pm-4:55pm at Mornington Basketball Stadium

$ 110.00 AUD Quantity

Total

$ 0.00 AUD

Player Details