2025/26 Summer Registration Form

Player Name

First NameLast Name
Guardian/Parents Names if under 18
Birth Date

DayMonthYear
Address
House Number, Street Name, Suburb and Post Code
Mobile Number
Format: 0000000000.
E-mail
2025/26 Grade Nominated
Player Fees - Information Only
Senior - $230 (Early Bird Fee $200)
Junior (U16 Girls) - $50
Sub Junior (U13 Mixed) -$50
Associate Member - $10 (coach, scorer etc)EARLY BIRD DISCOUNT - A $30.00 discount applies if your fees are paid in full by the Season Start Date.
Non Refundable Deposit
To secure your spot, a non-refundable deposit of $50 is required upon submission of this form. This fee will be credited towards your player fees. Bank details for your convenience:

Account Name: Breakaways Softball Club Inc
BSB: 016-499
ACC: 259232265
Ref : First Initial & Last Name NOM
Softball WA
A Softball WA registration is also required and there will be a fee associated with this. Breakaways will advise when this registration is required to be completed and what the fee will be.
Are you interested in Coaching or Scoring
Coaching or Scoring Grade
Do you require a uniform
I have read & understand and agree to abide by the Breakaways Code of Conduct for the 2025/26 playing season.
Should be Empty: