Team details:

Team

Sport

Day/Night

Season

Personal details:

First name

Last name

DOB

Street address

Suburb

Post code

Phone

Emergency contact:

First name

Last name

Phone

Relationship to player

Medical information:

Known allergies?NoYes

If yes, please specify

Known medical conditions?NoYes

If yes, please specify

Declaration and Signature:

I declare that the information provided by me on this form is true and correct.

YMCA program participants agree to adhere to centre conditions of entry. Conditions of entry and specific codes of conduct for program participation can be made available on request.

To the extent permitted by law, the Centre shall not be held liable or responsible to you for any direct, indirect or consequential injury, loss or damage.

I understand that photos may be taken by the YMCA for promotional purposes.

Player signature

Date

Parent/Guardian signature

Date

The Valleys Lifestyle Centre

Player Registration Form