Player Name
*
First Name
Last Name
Guardian/Parents Names if under 18
Date of Birth
*
/
Day
/
Month
Year
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Address
*
House Number, Street Name, Suburb and Post Code
Mobile Number
*
Format: 0000000000.
E-mail
*
2026/27 Grade Nominated
*
Please Select
B1
B2
B3
B4
C1
C2
C3
Juniors (U16 Girls)
Sub Juniors (U14 Girls)
Associate Member
Do you work FIFO
*
Please Select
Yes
No
Please Advise Your Current Roster
Player Fees - Information Only
Senior - TBA Junior (U16 Girls) - TBA Sub Junior (U14 Girls) - TBA 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
*
Please Select
Yes - Head Coach (if YES please select grade below)
Yes - Assistant Coach (if YES please select grade below)
Yes - Scorer (if YES please select grade below)
No
Coaching or Scoring Grade
*
Please Select
B1
B2
B3
B4
C1
C2
C3
Juniors (U16 Girls)
Sub Juniors (U14 Mixed)
N/A
Do you require a uniform
*
Please Select
Yes - Uniform Coordinator will be in contact with you
No
I have read & understand and agree to abide by the Breakaways Code of Conduct for the 2026/27 playing season.
*
Please Select
Yes - I agree to the above Code of Conduct
No
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