Titans Basketball Player Registration
Complete the registration by selecting your pathway and providing the required details and documents for review.
Club Registration
Which club are you registering with?
*
Greenlight Titans (Domestic Basketball)
United District Titans (District Basketball)
Both
Neither just carnivals
Registration Type
*
New Participant
Returning Participant
Player Registration Details
Player Photo
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Player First Name
*
Player Last Name
*
Preferred Name
Gender
Please Select
Female
Male
Non-binary
Prefer not to say
Self-describe
Unsure
Home Address
Suburb
Postcode
School Year Level
Please Select
Foundation
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Unsure
Date of Birth
*
-
Month
-
Day
Year
Date
Age
School
Parent/Guardian 1 Name
*
First Name
Middle Name
Last Name
Parent/Guardian 1 Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian 1 Email
example@example.com
Parent/Guardian 2 Name
*
First Name
Middle Name
Last Name
Parent/Guardian 2 Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian 2 Email
example@example.com
Emergency Contact Name
*
First Name
Middle Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship
Medicare Number include child reference number
Has the player any medical conditions?
Yes
No
Has the player ever had any allergies?
Yes
No
Has the player ever had any asthma?
Yes
No
Has the player ever had any injuries?
Yes
No
Does the player need any medication support?
Yes
No
Does the player need any other support needs?
Yes
No
Medical details
Medical Action Plan
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Medical History
Basketball History
Previous Club
Previous Team
Upcoming Age Group
*
Please Select
U8
U10
U12
U14
U16
U18
Open
Other
Preferred Position
Please Select
Guard
Forward
Center
Multiple
No Preference
Still Learning
Other
Sports Voucher Status
Please Select
Not applicable
Applied
Approved
Used
Other
Player Goals
Photo and Video Consent
*
I consent to photos
I consent to videos
I consent to use for club promotion
I do not consent
Acknowledgements and Declarations
*
Emergency treatment consent
No Pay No Play acknowledgement
Player code of conduct
Parent code of conduct
Child safe acknowledgement
Member protection acknowledgement
Social media policy acknowledgement
Anti-bullying acknowledgement
I declare the information provided is true and complete
Parent/Guardian Digital Signature
*
Volunteer and Workforce Details
Volunteer role interest
*
Coach
Assistant Coach
Team Manager
Referee
General Volunteer
Other
Workforce qualifications held
Working with Children Check (WWCC)
Responding to Risks of Harm, Abuse and Neglect (RRHAN)
Child Safe training
First Aid
CPR
Other
Coaching accreditations held
Foundation Coaching
Community Coaching
Level 1
Level 2
Other
Referee accreditations held
Community Referee
Level 1
Level 2
Other
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Photo and video consent
*
I consent to photos and video being taken and used for club and competition purposes
I do not consent
Emergency treatment consent
*
I authorise emergency medical treatment if required
I do not authorise emergency medical treatment
Welcome Pack commitment
Applicable to my role
Not applicable to my role
Child safe acknowledgement
*
I acknowledge the Child Safe requirements and responsibilities
Member protection acknowledgement
*
I acknowledge the Member Protection policy and responsibilities
Social media policy acknowledgement
*
I acknowledge the Social Media policy and responsibilities
Anti-bullying acknowledgement
*
I acknowledge the Anti-bullying policy and responsibilities
Are you interested in representing at SA Country Basketball Carnivals?
Expression of interest
Please Select
Yes – Definitely
Maybe – Please keep me informed
No
Age group
U12
U14
U16
U18
Tournaments interested in playing at
Murray Bridge
Barossa
Riverland
Yorkers
SA Country Championships
Declarations and additional comments
Digital signature
*
Date signed
*
-
Month
-
Day
Year
Date
Submit
Submit
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