2020 Redskins & Youth Leadership Member Details Form

2020 REDSKINS MEMBER DETAILS & CONSENT FORM
One form is required per parent/guardian

Multiple player members may be added under only one parent/guardian if they are the children - or in the care - of said parent/guardian.
Please use your discretion as to whether you are satisfied by the guardianship arrangements presented to you.
PARENT/ GUARDIAN DETAILS
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Parent/ Guardian Nationality*
Do you have a Medicare Card?*

YesNo
Do you have ambulance cover?*

YesNo
Do you have a current Healthcare or Concession card?*

YesNo
Do you have interest in volunteering while your child is playing?*

YesNo
EMERGENCY CONTACT DETAILS

The emergency contact must apply to ALL Player Members on this form - a new form is needed if this is not the case.
Emergency Contact for ALL Player Members on this form*

First NameLast Name
Relationship(s)*
Emergency Phone*
Preferred Medical Clinic *
Medical Clinic contact number*
Photography and Video

Photos or videos taken during your participation in our Les Twentyman Foundation programs may be used for promotional purposes for publications, brochures and online - including websites, social media and marketing collateral - to promote a range of initiatives and programs.

By signing this document you are granting your child's non-exclusive licence for their use.

I agree to give consent for the Les Twentyman Foundation and any person authorised by Redskins Basketball Club, to copy or reproduce images of my child/ children whether by photo, film or other electronic or printed media. For the purposes of promoting the Les Twentyman Foundation and or the Redskins Basketball Club.

Authorisation - I understand the conditions set out above, and hereby agree to the terms

Transport

I understand that it is my responsibility to ensure that my child/ children have appropriate transport to and from the venue.
Transport Responsibility*

I AgreeI DO NOT Agree
REGISTRATION FEE INFORMATION

FEB - JUNE
1 player is $180
Family is $340

JULY - DECEMBER
1 player is $200
Family is $380

All fees INCLUDE REGISTRATION, HIRE OF UNIFORM AND TRAINING

You will be invoiced for your registration fees, this can be paid upfront or in instalments, please contact us 9689 4800 to discuss your options.
1. PLAYER MEMBER DETAILS
Season*

Feb - JuneJuly - Dec
Player Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Phone Number*
Nationality*
Address (if different to parent/ guardian)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The player member is:*

MaleFemaleDiverse
Player Member ALLERGIES*
Player Member MEDICATION*
Player Member DIETARY*
Player Member INJURIES*
Player Member CONDITIONS*
eg. Asthma
Player Member AREAS OF CONCERN*
Is the player involved with any other Les Twentyman Foundation programs?*

EmbraceBack to SchoolUpgrade Homework ClubNot affiliated with any other programs
Do you have more players to add?*

No - all members addedYes - more players to add

Add another player
10. PLAYER MEMBER DETAILS
Season*

Feb - JuneJuly - Dec
Player Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Phone Number*
Nationality*
Address (if different to parent/ guardian)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The player member is:*

MaleFemaleDiverse
Player Member ALLERGIES*
Player Member MEDICATION*
Player Member DIETARY*
Player Member INJURIES*
Player Member CONDITIONS*
eg. Asthma
Player Member AREAS OF CONCERN*
Is the player involved with any other Les Twentyman Foundation programs?*

EmbraceBack to SchoolUpgrade Homework ClubNot affiliated with any other programs
SIGNED (Please sign with your mouse on computer, or finger on touch screen)*
Date*

DayMonthYear
DateHourMinutesAM/PM Option
Should be Empty: