Two Wells Football & Netball Sporting Club Incorporated
PO Box 210
TWO WELLS 5501
www.twfnsc.com.au
SENIOR PLAYER REGISTRATION/MEMBERSHIP FORM 2014
FEES: ALL SENIOR FEES $120
FULL TIME STUDENTS $80 (evidence of study required)
FEES REQUIRED BY THE THIRD PLAYING MATCH
PLAYER INFORMATION:
Name:
Address:
Residential:
Mailing Address:
Mobile:
Email Address: (any email correspondence will be sent to this address)
NOMINATING FOR:
Football:
Netball:
Preferred Position(s):
Were you registered with TWFNSC in the last season:
Yes
No
Please note: clearance may be required from previous club.
If no, please state which club you were registered with:
EMERGENCY CONTACT INFORMATION:
Name:
Relationship:
Contact Address:
Contact number
MEDICAL INFORMATION
Do you suffer from any allergy, medical condition or are you allergic to any medication?
Details:
Yes
No
PLEASE NOTE: MEMBERSHIP DOES NOT PROVIDE AMBULANCE COVER FOR ANY PLAYERS/MEMBERS. The club
recommends all players have ambulance cover. Application forms are available at the office, or go to
www.saambulance.com.au
The wellbeing of the player is the clubs’ first priority and, if required, an ambulance may be called. In this case, I authorise the
Two Wells Football & Netball Sporting Club represented by a coach, team manager, trainer or official to call an ambulance
and/or to obtain further assistance if deemed necessary.
I understand that all associated costs incurred as a result of any action taken in this regard will be my responsibility.
NOTE: PLAYERS WHO REQUIRE REGULAR STRAPPING MAY BE ASKED TO PAY.
(PLAYERS WHO REQUIRE REGULAR STRAPPING WILL REQUIRE EVIDENCE FROM MEDICAL PRACTITIONER)
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Two Wells Football & Netball Sporting Club Incorporated
PO Box 210
TWO WELLS 5501
www.twfnsc.com.au
PRIVACY
Personal information collected is for the primary purpose of membership requirements and/or competition purposes. It will not
be released for any form of commercial gain and will be maintained in a secure environment. Completion and lodgement of this
form indicates acceptance of the Clubs policies and abides by the constitution. Club and player details may appear on club
and/or association information such as newsletters and websites.
Player photographs may appear in publications relating to the Two Wells Football & Netball Sporting Club, the Adelaide Plains
Football League and the Adelaide Plains Netball Association.
Any objections need to be advised to the club and/or league/association in writing.
WAIVER AND INDEMNITY
I am aware that playing, observing, training for football and netball and participating in any activity carried out by the club are
activities that inherently involve risk, and that in undertaking these activities my child does so at his/her risk.
I have voluntarily read and understood this information and accept and assume the inherent risks in participating in football and
netball activities.
AGREEMENT
All players are bound by and agree to comply with the Constitution, Regulations and Policies of the TWFNSC.
The Two Wells Football & Netball Sporting Club reserves the right to refuse applications for membership.
The application must be signed PRIOR to the player participating in football/netball.
Unsigned forms will be returned.
Player Name:
Date:
Signed:
Please forward this completed registration form including any additional information to:
Post:
Two Wells Football & Netball Sporting Club Incorporated
PO Box 210
Two Wells SA 5501
Email:
twowellsfc@sanflcfl.com.au
or
In Person:
Two Wells Football & Netball Sporting Club
Old Pt Wakefield Rd
Two Wells 5501
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