2022 Breakers Parent/Player Contract and Deposit

2022 Breakers Parent/Player Contract and Deposit
Player Details
Name*

First NameLast Name
Gender*
Date of Birth*

DayMonthYear
Date
2022 Squad*
Address*

Street Address

Street Address Line 2

SuburbState

Postcode
Is your most recent VJBL club Mornington Breakers?*

YesNoNew to VJBL
If "No" name of club
Copy of Birth Certificate (New Players ONLY)

Cancelof
Medical Information
Is your child fully vaccinated against Covid-19 (double dosed)?*

YesNoMy child has an exemptionMy child is under 12 years and 2 months old
Does your child suffer from any of the following?

AsthmaEpilepsyDiabeteAllergiesOther
Other: Please State
Does your child use regular medication?

YesNo
If "Yes" please provide details
If you have selected "Yes" to either Asthma or Allergies you must submit an Asthma or Allergy Management Plan. Players will not be permitted to play until this information has been provided.

Cancelof
Consent to Medical Treatment
I authorise officials, coaches and team managers to obtain for my child any necessary medical treatment by appropriate medical practitioners in the event of injury in my absence and where impractical to communicate with me. Should it be necessary to call an ambulance for my child, I accept full responsibility for any cost incurred.
Parent/Guardian Signature*

Clear
Emergency Contact Details
Contact 1 Name*

First NameLast Name
Contact 1 Mobile Number*
Contact 2 Name*

First NameLast Name
Contact 2 Mobile Number*
Parent and Player Contract
Terms and Conditions*

I will attend all compulsory weekly training sessions and all scheduled matches.I will respect the coaching staff, team, club officials and will follow all instructions at training and games.I understand that court time is not guaranteed and is at the coaches discretion.I declare that I have not been found guilty of misconduct, been suspended, have had my membership declined, been removed or expelled or have had any disciplinary matters investigated or heard against myself or my child within a Basketball Association or affiliation of Basketball Victoria or Basketball Australia.I have read and will abide by Basketball Victoria's Code of Conduct, MDBA By Laws and Rules of the Association.I understand that Breakers club fees must be paid on time, failure to adhere to this may lead to a player being removed from the team unless prior alternative arrangements have been made with the MDBA General Manager.I have read and understand the the Mornington District Basketball Association "Refund Policy" attached to this agreement. I will ensure that match fees and any other associated fees are paid in advance or as requested by the Team Manager or Club.I will wear the Mornington Breakers uniform with pride and ensure it is well maintained.I give permission for photos taken of me to be used for any promotional material by Mornington District Basketball Association.I have read and understand the information provided in the Player/Parent HandbookI understand and will comply with the MDBA vaccine requirements and VJBL vaccine requirements being all individuals aged over 12-and-2-months to be fully vaccinated (unless medically exempt) to participate including parents, spectators, team staff. I understand that if I am (12-and-2-months or older) I will be required to check in via the venue QR Code and their smart-phone and will need to show their green tick via the Services Victoria App.
Term and Conditions to be viewed via our website: https://www.morningtonbasketball.com.au/wp-content/uploads/2021/11/Terms-and-Conditions-of-registration-website-4-Nov-21.pdf

Conditions of Entry into Mornington Basketball Venues: https://www.morningtonbasketball.com.au/conditions-of-entry/
Parent 1 Name*

First NameLast Name
Parent 2 Name*

First NameLast Name
Parent Mobile 1*
Parent Mobile 2*
Parent 1 Email*
example@example.com
Parent 2 Email*
example@example.com
Parent/Guardian Sign*

Clear
Player Sign*

Clear
Deposit Payment

My Products*

2022 Player DepositPlease enter a short description.

$100.00AUD Quantity

Enter coupon

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

2022 Breakers Parent/Player Contract and Deposit

Player Details

Medical Information

Consent to Medical Treatment

Emergency Contact Details

Parent and Player Contract

Deposit Payment