USC Lion Volleyball Club Registration Form

USC Lion Volleyball Club Registration Form
Player Information
Full Name *

First Name Last Name
Gender *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Mobile Number *
Date of Birth *

Month Day Year
E-mail *

Parent/Caregiver Information
Are you under the age of 18?
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Mobile Number *
E-mail *

Payment Details
Senior Fees are due by the 1st of April.

Junior Fees are due by the 1st of May.

Uniform cost is approximately $65.

A $50 late fee will apply if fees are not paid by the start of the season.
Team/Cost *
NOTE: ALL PLAYERS ARE REQUIRED TO PAY VSA FEES DIRECTLY TO VSA PRIOR TO 31st MARCH 2016 TO PLAY. THIS WILL VARY ON AGE
Payment Method *

Cash Bank Transfer Cheque
Cash Paid To *
Cash Date Paid *
Bank Transfer

Name: USC LION VOLLEYBALL CLUB

BSB: 035 053

Account Number: 301 894

Reference: Players Name

Cheque

Made payable to: USC LION VOLLEYBALL CLUB INC.

Help Needed
Please tick the tasks you ar able to do to help out the club
Help Needed

Be a team manager Be a coach Fundraising

Signatures
I agree to show good sportsmanship whilst representing the USC Lion Volleyball Club both on and off the court
Player Signature *

Clear
Date *

Month Day Year
Parent/Caregiver Signature

Clear
Date

Month Day Year

Photographic/Media Consent
INFORMATION

I hereby consent to the collection and use of my personal images by photography or video recording.

I acknowledge these may be used on the USC Volleyball website, in newsletters and publications as well as distributed to members.

I further acknowledge that my image may be used by the USC Lion Volleyball Club to promote the club.

I understand that no personal information, such as names, will be used in any publications unless express consent is given.

I also understand that my consent can be withdrawn at anytime in writing to the Secretary of the USC Lion Volleyball Club.
Insert Name
(Name of person giving consent & parent/guardian if under 18 years of age)

Consent to the use of photographs or video footage for use on the USC Lion Volleyball Club website, in newsletters and publications as well as for distribution to members.

Consent to the use of photographs or video footage being used to promote the USC Lion Volleyball Club

I further understand that this consent may be withdrawn by me at anytime, upon written notice.

I give this consent voluntarily.
Player Signature *

Clear
Date *

Month Day Year
Parent/Caregiver Signature

Clear
Date

Month Day Year

Please rate how easy it was for you to complete this form *
Feedback/Other Comments or Notes
Should be Empty:

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