Membership Registration

Registration & Payment

Runcorn Rockets Basketball - Season 2, 2020

Club Registration Form



ANNUAL REGISTRATION FEE: $45 per family

(Coach Only: No Charge, Volunteer Only: No Charge)

New Members Only. If you paid in season 1 you don’t pay again.


TERM 3 MEMBERSHIP FEE (Rockets Games and Training)
(U8-Miniball = $90, U10 = $125, U12-U20 = $145, Train Only = $80)

(10% discount off seasonal membership fee once you have 2 or more children to register)

Rockets Registration Fees covers administration End of Year Presentation.

If any player is under the age of 18 then "Parent(s) / Guardian(s) Details" must be completed.

Payment can be made via credit or debit card, cash, cheque made payable to RUNCORN ROCKETS or EFT to Runcorn Rockets BSB 124001 Acc No. 22964356

On all EFT payments please email payment confirmation to runcornrockets@gmail.com



Season *


Player / Coach / Volunteer Registration

Title
Given Name *
Surname *
Date of Birth *
dd/mm/yyyy (e.g. 15/01/2015)
Gender *


Type of Membership *

Check all the boxes that apply to you.





Current School
Blue Card No.

Coach or Volunteers only


Contact Information - must be completed in FULL

Preferred Email Address *

Email address to receive receipts, e-Newsletters, and etc.

Confirm email *
Preferred Contact Number (Mobile Phone) *
Address *
Suburb *
Post Code *
Other Contact Number

Mobile Phone, Home Phone, Work Phone, etc.


Parent(s) / Guardian(s) Details - Primary Contact
(Please complete for players who are under 18)

Email Address (Cc) *

If you are adult and registering yourself, enter your own email address.

Title
Given Name
Surname
Relationship
Occupation
Preferred Contact Number

Mobile Phone, Home Phone, Work Phone, etc.


Parent(s) / Guardian(s) Details - Secondary Contact

Email Address
Title
Given Name
Surname
Relationship
Occupation
Preferred Contact Number

Mobile Phone, Home Phone, Work Phone, etc.


Fee Payment
(Please refer to the "Registration Info" webpage for the details.)

Annual Registration Fee (Per Family) *

Once you have two or more players to register, choose "Annual Registration Fee (Per Family)..." when you register the first player, and then choose "I already paid when I registered the first player. - $0" when you register the other player(s).

Age Group & Seasonal Membership Fee *
10% Discount off Seasonal Membership Fee

Please tick once you have 2 or more children to register. ("Training Only" does not apply.)


Get Started Voucher ?

Get Started Vouchers (up to the value of $150) - funding to help young people participate. Click on the link to check the eligibility and to apply for funding for your child Get Started Voucher.
https://www.qld.gov.au/recreation/sports/funding/getinthegame/getstarted/


Payment Method *

If you choose "Credit or Debit Card" as payment method, there is an extra fee charged by our Financial Services Provider for card payment(approximately 2.6%) and this will apply per each transaction.

SWM_Rego *

Is player registered with South West Metro Basketball Association?




Declaration

Player Declaration / Parent's Consent *


Player's Declaration

I, Hereby agree as follows:

  • I will conduct myself and endeavour to ensure others in my company conduct themselves in a proper and reasonable manner and in accordance with Basketball’s Codes of Conduct, a copy of which is available from Basketball Australia, Basketball Queensland, and South Western Metro Basketball Association, Runcorn Rockets or from their internet sites.
  • I agree to be bound by the Runcorn Rockets, South Western Metro Basketball Association ’s, Basketball Australia’s and Basketball Queensland’s constitution, rules and by-laws and the conditions of entry into the basketball facility and to submit myself to the jurisdiction of their Tribunal, Member Protection Tribunal and any other disciplinary forum connected with basketball.
  • I agree to comply with any reasonable direction of any official connected with basketball.
  • I acknowledge that I am aware that there will only be limited times when a person qualified in first aid is present.
  • I authorise the club, association, league, Basketball Australia or Basketball Queensland to obtain medical treatment for me or my child should there be an emergency and it is not possible or reasonably practical for me to do so and acknowledge that the cost of any ambulance or medical treatment will be my sole responsibility.
  • I advise I have or my child has the following medical conditions including allergies and warrant that I am or my child is fit to play basketball and will notify the association should any new medical information become available:
  • Unless I delete any item I consent to the following:

(a) I or my child’s name (but not address) may be mentioned in any newsletter (whether printed or electronic) in reports about games and achievements

(b) I or my child may be photographed and any photograph used in any newsletter (whether printed or electronic) or for promotion of basketball

(c) Videos may be taken of me or my child playing or training to be used for family keepsakes by family members of other players, or by or for coaching staff to be used for coaching or scouting purposes

(d) Information about basketball will be sent to me from time to time by mail or email.

  • I will not photograph or video any activity in which I or my child is involved unless I make known to the coach or team manager who I am and that I propose to take photographs or video a game.
  • I will be responsible for any damage to property and equipment caused by me or my child and pay for such damage on demand
  • .I will offer my services to assist the association in any way that I can in the conduct of competitions or otherwise and advise that I have the following particular qualifications or abilities which I am prepared to make available to the association from time to time:

Parent's Consent (for players under 18)

I/We being the mother/father/guardian of the above player who is under the age of eighteen guarantee due performance by the player of all terms and conditions of this agreement and to the extent that they also apply to me, agree to be bound by those same terms and conditions. I will endeavour to be present or ensure a responsible adult is present at all games, training sessions and other basketball activities in which my child is involved.


Note to Administrator
Security Number : .
Please enter this number.




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