Club Membership Registration Form

Mystic Opals Netball Club Registration Form

Complete the form below to sign up for our membership service.
Name:

First NameLast Name
E-mail:
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender:

FemaleMale
Birth Date:

MonthDayYear
Where did you hear about us?

A Friend or Family MemberFacebookGoogle
I am willing to help out with (this includes parents of junior):

UmpiringCoachingFundraisingCarnivals/EventsSponsorshipBeing a Committee MemberOther
Are you willing to supply us with a National Police Clearance for the above roles ($42.00 for 12 months)

YesNo
Medical Conditions:
Emergency Contact
Name
Number
Relationship to Player
Do you/your child have a medical condition that we may need to be aware of? Yes/No please give details
Grading Information
Are you a:

Returning Player (includes playing recently in a different club)New player (new to netball or haven't played in a while)
What Category are you interested in playing in (multiple choice):

Net Set Go (U/9s)Juniors (10-15)Intermediates (15-17)Seniors (14+)
Preferred Positions:

GSGAWACWDGDGK
Last Club/Association Played For:
Grade:
Year:
Reason for leaving?:
What days can you NOT attend training due to other commitments?:

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Are you hoping to play at a high level/competitive level?

YesNoDoesn't matter as long as its fun
Do you have any friends/family in the club (name 3):

Mystic Opals Netball Club Registration Form