2025 Regionals Junior Hockey Championship - Pt Lincoln
South Coast Team registration
Players Name
*
First Name
Last Name
Preferred Name
This is only required if they go by another name other than their Birth name.
Player's Date of Birth
*
-
Month
-
Day
Year
Date
Male
Female
Name of Parent or Guardian
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City/Town
State
Post Code
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Emergency contact Name
Emergency Contact Phone Number
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"Are there any health conditions that we should be aware of? If treatment is needed, what specific treatment would you prefer to be administered?"
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Please complete this section if you are not accompanying your child to Regionals
Medicare number
Do you have Ambulance cover
Yes
No
Do you have Hospital Cover
Yes
No
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Parent Participation
Would you be able to assist with any of the following tasks?
Coaching
Team manager
Umpiring
Transport other players
Organising Saturday's community meal
As part of our responsibility to ensure the well-being of our players, we are required to provide first aid if needed. Do you have the necessary qualifications to administer first aid, and would you be willing to assist any player in need?
Doctor
Nurse
Ambulance officer
First Aid Trained
Other
Phone Number for coaches or team managers to ring you if they need assistance.
Please enter a valid phone number.
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Consent
I consent to photographs being used to promote South Coast Hockey Association
*
Yes
No
I have read the code of conduct and will abide by it. You can find it here: https://southcoasthockey.org.au/wp-content/uploads/2020/05/SCHA-code-of-conduct.pdf
*
Yes
No
I agree to allow my Child/Ward playing in the Regional Junior Championship. I further authorize any member or other official representative of the South Coast Hockey Association to obtain any medical or Dental attention/treatment or ambulance assistance considered necessary (or expedient) for the player. I understand any cost incurred will not be covered by the South Coast Hockey Association and will reimburse any expenses which may be incurred. I further agree not to make a claim against the South Coast Hockey Association.
Yes
No
Name
*
First Name
Last Name
Signature
*
Date
*
-
Month
-
Day
Year
Date
Type a question
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