Bourchier Street Soccer Club
Player Registration Form 2025
Player Details
(child's details here)
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Player Date of Birth
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Tick for Girls Only Competition
Girls Only Competition
Player's Soccer Shirt Size
Please Select
Size 4
Size 6
Size 8
Size 10
Size 12
Size 14
Size 16
Parent / Guardian Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
Please name someone (not a Parent) who can be contacted in case of emergency
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Media Release Agreement. I give permission for the SJSA to use my child’s name & image in print & digital media including the SJSA Facebook Page, Instagram & website.
*
Yes
No
Support to SJSA during the season. All schools & clubs will be rostered once or twice during the season to assist with ground set-up / pack-upor to assist in the Canteen / BBQ. I acknowledge that I will be rostered to assist on that / those day(s).
*
Yes
Medical Information. Do you have any medical conditions that we should be aware of?
*
Yes
No
Do you have a medical action plan? If Yes, a copy must be provided
*
Yes
No
Do You have any serious allergies that we should be aware of? If Yes, Please provide details
*
Yes
No
Complaints & Disciplinary Procedures & Parent / Guardian Complaints & Concerns Should in the first instance be directed to the School / Club Delegate. If a resolution is not able to be achieved, the matter should be referred to the SJSA Executive. Disciplinary matters will be dealt with according to the SJSA Disciplinary Procedure & Policy. It is mandatory that all players & parents / guardians read the Code of Conduct & Social Media Policy. Registrations will not be processed if the Code of Conduct & Social Media Policy Agreements have not been acknowledged & compliance with agreed to.
Read
Player Code of Conduct & Social Media Agreement. I have read the Player’s Code of Conduct & the Social Media Policy & hereby agree to comply with both throughout the soccer season. I understand that the Code of Conduct applies to both training & game day. I also understand that failure to comply with the Code of Conduct or the Social Media Policy will be dealt with by my school or club & in extreme cases by the Executive of the Shepparton Junior Soccer Association. I also understand that repeated breeches of the Code of Conduct or Social Media Policy after such discussions will result in my expulsion from SJSA.
*
Yes
Parent / Guardian Code of Conduct & Social Media Agreement. I/We have read the Player’s Code of Conduct & the Social Media Policy & hereby agree to comply with both throughout the soccer season. I/We also agree to support my/our child(ren) in complying with the Player’s Code of Conduct & Social Media Policy. I/We understand that failure to comply with the Code of Conduct or the Social Media Policy will be dealt with by my school or club & in extreme cases by the Executive of the Shepparton Junior Soccer Association. I/We also agree to take responsibility for any spectators that may accompany me/us to watch my/our child(ren) at training or on game day.
*
Yes
Indemnity Agreement & Consent for Medical Treatment. In consideration of the Shepparton Junior Soccer Association accepting the above-named player as a member of the said Association, I agree & do hereby indemnify the said Association, its Officers, Agents, Coaches or Referees inforas & to the extent which the Association, its Officers, Agents, Coaches or Referees are not entitled to be indemnified under any policy of insurance whatsoever from & against any damages, claims, or demands arising out of any accident or illness which may have befallen or occur to the said player during his or her participation in soccer matches or other functions connected with the Association or when traveling to & from such matches or functions. I aIso authorise any Officers, Agents, Referees or Coaches of the said Association in the event of such an accident or illness to obtain any necessary medical assistance or treatment & for this purpose engage any Doctors, Nursing assistance or Hospital accommodation & in this event, I agree to pay all such Doctors, Nurses or Hospital fees & expenses other than fees & expenses recoverable under any policy of insurance.The SJSA carries extensive Public Liability Insurance. This policy DOES NOT cover MEDICAL TRANSPORT and ANCILLARY EXPENSES associated with sports injuries. Parents and Guardians are advised that Ambulance Subscription & Accident Insurance will offset costs not covered by the normal Medicare rebate. I have read & agree to the terms on the Indemnity Agreement & Consent to Medical Treatment.
*
Yes
Please note! Payment for Soccer is paid in two parts.
Soccer is $150 in total per player. However you must pay $43 to Bourchier St Soccer Club and $107 to PlayFootball which will happen via their separate player registration page (link to follow).
Payment of Registration. How are you paying? Preferred payment method is Credit Card. Cash can be dropped into the School office. Direct Deposit details are: Account Name: Bourchier Street Soccer Club BSB: 033254 Acc No: 638005
*
Credit Card
Cash
Direct Deposit
Tick Box to pay with Credit Card
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Season 2025 Fee Bourchier Street Soccer Club part of fee
$43.00 AUD
$
43.00
AUD
Credit Card
Submit
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