Registration Registration Form Web Site First Name * Last Name * Street Address * City * State * NSW VIC Email * Phone * Date of Birth * Gender * Male Female Other Hockey ACT Number (if known) ~ Type '00' if unknown * Highest level of Hockey (winter competition 2024) you have played * JDK Management Competition -02 Oct 2024 - 12th Feb 2025 Team - Competition Selection * Premier (Mixed) Senior Men Senior Women Junior mixed (under 14) FEE'S * Agree Disagree Fees can be paid in person a week before to the 1st week of play - JDK Management Comp - $200 Premier & Senior | $125 U14 comp. Rules * Agree Disagree 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.n Uniforms * Agree I acknowledge that my uniform stays the property of Border Indoor Hockey. A levy is included as part of my registration fees. I am required to return my uniform at the end of the season competition. Who is your winter club? * Have you played Indoor with Border Indoor before? * Yes No Photographs * Agree Disagree I give permission for Photographs of myself/my child to appear on the www.borderindoorhockey.com website or in other forms of media releases & to include my name. Code of Conduct * Agree Disagree 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. Emergency Contact Person * Emergency Contact Person Phone * Indoor Help * Umpire Coach Manager Set up Score the game EXPRESSION OF INTEREST: PLAYERS, PARENTS, SPECTATORS & other SUPPORTERS please tick many areas you may be interested in assisting, supporting or becoming involved in, with Border Indoor Hockey. All players are to pack down at the end of the last game. Health Statement * Please disclose any chronic or recurrent ailments, allergy or a physical condition so that the correct information ca be provided to a health official in case of an emergency. Date * Name/Signature * Name & Validation of the applicant or guardian/parent (if the applicant is 18 years or under) Name: Signature* Your application is subject to approval by Border Indoor Hockey committee. Approval Your application is subject to approval by Border Indoor Hockey committee. Wodonga Hockey Club Inc. trading as Border Indoor Hockey Please click Submit ~ then payment into bank account Direct Deposit BSB: 640 000 Acc: 111 219 688 Ref: Surname, First name Premier & Seniors = $200 U14 Comp. = $125
