Junior Registration – Mooroolbark Soccer Club

My Child's Name *

First

Last

Child's date of birth *

Child's Gender *

Male
Female

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mobile Phone *

Email *

Email

Confirm Email

Preferred methods of contact *

Medical conditions I want the Club to know about

I am interested in volunteering as

Team Manager
Coach
First Aid
Other

To help the club get to know you, what are your occupations? *

Comment or Message

Accident and Injury Disclaimer: Mooroolbark Soccer Club ("The Club") including any of its officers and/or members shall not be held responsible for any accident, illness or injury sustained while playing at, or attending any function with, The Club. I understand that The Club carries only basic player’s insurance (provided through registration with FV) and that it is my responsibility to arrange additional insurance cover. The Club recommends that every player takes out their own private health insurance. I also give my permission for The Club to arrange medical attention that may be deemed necessary including ambulance transport and I agree to pay for all such costs incurred ( emergency ambulance transport costs once paid can be claimed via player insurance ) The Club agrees that it will do its utmost to seek or obtain my and/or parental consent, if possible, prior to seeking medical treatment for me, but I understand and accept that it may not be possible to do so in the circumstances. The Club agrees to make every effort to contact my emergency contact/parent, where necessary and as soon as it is practicable to do so. Agreement: I hereby apply to be registered as a player of Mooroolbark Soccer Club. I agree to abide by the rules of the Club’s Constitution and FFA/FFV codes of conduct as a player/spectator. I will abide with the clubs code of conduct regarding interactions with club officials, parents, coaches and volunteers. *

I have read and agree to the above conditions of members

Payment

All 2022 registrations for MiniRoos through to U18s will receive a Barkers KonQa spray jacket as well as being equipped with shorts, socks and playing jersey.

Sizes: 6, 8, 10, 12, 14 Adult Sizes: XS, S, M, L, XL, 2XL, 3XL

Jacket Size *

Shorts Size *

Is this the first child you are registering this year? *

Yes
No

Registration Type *

Clinic: birth year 2015-2016....... Miniroos: birth year 2011-2014...... Juniors: birth year 2004-2010

Registration Type (sibling discount) *

Clinic: birth year 2015-2016....... Miniroos: birth year 2011-2014...... Juniors: birth year 2004-2010

Total

$ 0.00

Please Press Purchase Only Once *

Card

Name on Card