Sports Registration and Payment Form 2015
Welcome
Rose Park Primary School has a strong
tradition of student involvement in after
school sports. With the assistance of
parent/carer volunteers in coordinating,
coaching and managing positions we are
able to offer a large range of sports.
More information and contact details for
each sport are on the Sports Notice
Board.
Fees for 2015
Players are not
registered until
payment is
received.
$70 for one sport
$130 for unlimited
sports!
How to Register
Keep this page for your
reference. Complete the second
page of this form and return to
Front Office with payment by the
due
date.
Deadlines
for
nomination may vary between
sports. Early return of forms is
appreciated as this greatly
assists with team planning. 
What Happens Next?
You should receive a
note or email or text
from the coach/manager
for each nominated
sport at least 1 week
prior to first game. First
trainings usually week or
two before first game.
Please note:
Information provided below is based on previous years’ experiences and is intended as a guide only. There is a small possibility of
changes by the organising association or coach.
SPORT
DUE DATE
Summer Basketball
Term 4, 2015 & Term 1, 2016
4 August, 2015
(You must return the nomination
form by this date. Earlier return
of forms is appreciated)
Season
Summer: Term 4, 2015 & Term 1, 2016
Gender
Mixed
Eligibility
Years 2 to 7
Trainings
Once a week before or after school. Times to be confirmed as determined by each team.
Games
Matches of approximately 35 minutes duration are held every week of the school term at Life Be In It,
Unley. Usual match times are 4pm, 4.40pm and 5.20pm. Year 2-3 play Tuesdays, Year 4-5 play
Thursdays and Year 6-7 play Wednesdays. Occasional 6pm matches are scheduled during busy
seasons.
Uniform
Rose Park Primary School assigned basketball singlet, blue shorts (no visible pockets), appropriate
footwear.
Other requirements
Mouthguard is optional.
Other comments
Players will be divided into teams based on age and experience in order to balance team numbers.
Beginners at all year levels are very welcome!
Questions?
Contact the basketball coordinator:
Mo Qureshi
Mob 0468345212
Email mqny@hotmail.com
Rose Park Primary School 2015 SUMMER BASKETBALL NOMINATION
Season: Summer Term 4, 2015 & Term 1, 2016
PLAYER PERSONAL DETAILS
First Name: ______________________________
Family Name: _______________________________ Age Now: ________
Date of Birth: ______________ Year Level: ______ Class Teacher: __________________________ Room Number: _______
Medical Information: Please complete and attach additional information if required.
Allergies
Yes / No
Allergy Details:
Asthma
Yes / No
Any other existing ailments or medical issues? Please provide details here.
Diabetes
Yes / No
Heart Condition
Yes / No
PARENT/CARER DETAILS
Parent/Carer 1
Parent/Carer 2
Name: ________________________________________
Name: ________________________________________
Mobile: _________________________
Mobile: _________________________
Email: ___________________________________________
Email: ___________________________________________


Tick box if you want to receive messages from coach/manager re
trainings, games, general information etc
Tick box if you can be contacted in the event of emergency


Tick box if you want to receive messages from coach/manager re
trainings, games, general information etc
Tick box if you can be contacted in the event of emergency
OTHER EMERGENCY CONTACTS
If parent(s)/carer(s) can’t be contacted in the event of an emergency, please provide additional emergency contacts below:
Name: _____________________________ Relationship to player: ____________________ Phone: ______________________
Name: _____________________________ Relationship to player: ____________________ Phone: ______________________
HOW CAN YOU HELP?
No coach = No team. Many hands make light work and every bit helps. You don’t have to know how to play the game to help.
Parent/Carer Name
I am happy to (please tick all that apply): (note not every sport requires all these helpers) 
Coach
Assist. Coach
Manager
Assist.
Manager
Help at Games
Help at Trainings
PARENT/CARER ACKNOWLEDGEMENT
NOTE: Rose Park Primary School Sports Policy document is available on the school website or from the Front Office.
I understand that registration to play in an after school sport team for Rose Park Primary is not completed until payment has been
made. I have read and understood the requirements of both player and parents in registering for after school sporting teams as
detailed in the School Sports Policy.
Name of Parent/Carer completing this form: ________________________________ Signed: ____________________________
PAYMENT ADVICE
Player Name: ______________________________ 2015 Sport(s) __________________________________________________
 TICK THIS BOX IF YOU HAVE ALREADY PAID FOR MULTIPLE SPORTS THIS YEAR AND NO FURTHER PAYMENT REQUIRED.
Method of Payment:
 Cheque
 Cash
 Visa
 MasterCard
 Bizgate
Card Number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Expiry: ____/_____ CCV No. ___ ___ ___ I authorise the school to draw on my Visa/MasterCard for the amount of $ _____
Name of Cardholder: ______________________________________ Authorisation Signature: _________________________
Office Use Only:
Receipt Number: __________________________________________ Date: ______________________