REGISTRATION – Border Indoor Hockey

Registration Form

First Name
Last Name
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Email
Phone
Male / Female
MaleFemale
Date of Birth
Hockey Victoria Number (if known)
Highest level of Hockey (winter competition) you have played in 2018 ?
Team - Competition Selection
JDK Management Competition -10th Oct - 19th Dec 2018
Premier (Mixed)Senior MenSenior WomenUnder 12 mixedUnder 15 mixed
BiH Mixed Social Competition - 23rd Jan - 13th March 2019
Mixed SeniorsUnder 12's mixedUnder 15's mixed
Combined - JDK Management Comp + BiH Social comp.
Premier League - mixedSenior MenSenior WomenUnder 15's mixedUnder 12's mixed
Who is your winter club?
Fee's
Fees can be paid in person a week before too the first week of play -- JDK Management Comp = 10th Oct - 19th Dec 2018 $100 (Junior Comp.) $120 (Senior Comp.) ---BiH Mixed Social Comp = 23rd Jan - 13th March 2019 $80 (Junior Comp.) $90 (Senior Comp.) --- COMBINED = Both comps ( Big savings) 18 rounds $160 (Juniors) $190 (Seniors)AgreeDisagree
Rules
In the event of my/my child's admission as a member, I/my child agree to be bound by the rules of the Border Indoor Hockey for the period of membership.AgreeDisagree
Photographs
I give permission for Photographs of myself/my child to appear on the www.borderindoorhockey.com.au website or in other forms of media releases & to include my name.AgreeDisagree
Uniform *
I acknowledge that my uniform stays the property of Border Indoor Hockey. A levy is included as part of my registration fee’s. I am required to return my uniform at the end of the season competition.Yes
Code of Conduct
I/and or my child have read & understood & agree to abide by the "Code of Conduct" of Border Indoor Hockey. - All members & supporters of Border Indoor Hockey shall conduct themselves in the spirit of good sportsmanship & show respect to teammates, officials & spectators at all time.AgreeDisagree
Emergency Contact Person
Emergency Contact Person Phone
Indoor Help
EXPRESSION OF INTEREST: PLAYERS, PARENTS, SPECTATORS & other SUPPORTERS please tick any areas you may be interested in assisting, supporting or becoming involved in, with Border Indoor Hockey.UmpireCoachManagerScore the gameSet up
Date
Name / Signature Name & Validation of the applicant or guardian/parent (if the applicant is 16 years or under) NAME: SIGNATURE: * Your application is subject to approval by Border Indoor Hockey committee
Health Statement Please disclose any chronic or recurrent ailments, allergy or a physical condition so that the correct information can be provided to a health official in case of an emergency.

Pos	Club	W	L	PTS
1	Linfox	1	0	3
2	Grealy Motors	0	0	1
3	McDonalds	0	0	1
4	BYE	0	0	0
5	Hume	0	0	0
6	Blazing Stump	0	1	0

Pos	Club	W	L	PTS
1	Pink	1	0	3
2	Supaturf	1	0	3
3	BYE	0	0	0
4	Green	0	0	0
5	Orange	0	1	0
6	Blue.	0	1	0

Pos	Club	W	L	PTS
1	BYE	0	0	0
2	Orange Suns	0	0	0
3	Pink Panthers	0	0	0
4	White Tigers	0	0	0
5	Yellow Stars	0	0	0

Pos	Club	W	L	PTS
1	Maroon	1	0	3
2	Purple	1	0	3
3	BYE	0	0	0
4	Blue	0	0	0
5	Black	0	1	0

Registration Form

Verification