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Player Registration Form
2019 Fee packages

Miniroos ( Clinic ) Under 5 - Under 7 years $250.00
Under 7 - Under 11 years $400.00
JUNIOR Under 12 - Under 18 years $480.00
FAMILY Sibling discount - $50.00 for 2nd and subsequent child -maximum $100.00

UNDER 20 (No Senior or Reserve games). $510.00
SENIOR MEN 18 years + $550.00*
SENIOR WOMEN 18 years + $550.00*
BAYSIDE VETS & 3RDS Vets must be over 35 $160.00
Snr player Sponsor $720.00


PLEASE NOTE ALL FEES ARE PAYABLE BY 21/3/19, NO PLAYER WILL BE REGISTERED TO PLAY UNTIL FEES ARE PAID IN FULL

* Senior players will be requested to undertake a 2 x club duties
This includes staffing bar, marshaling, canteen etc-

Email address *
Player's name *
Your answer
Date of birth *
Your answer
Address *
Your answer
Emergency Contact Details - Name/contact number *
Your answer
If under 18 years old please provide parent/guardian name - as you are a junior member this person will act on your behalf for club Annual General Meeting etc
Your answer
For club information please advise if you have any medical conditions/allergies that club and/or coach should be aware of ( if none please respond "NIL" ) *
Your answer
For club information, please detail any medications required before/during/after a match/training session that the club and/or coach should be aware of
Your answer
Accident and Injury Disclaimer: Mooroolbark Soccer Club ("The Club") including any of its officers and/or members shall not be held responsible for any accident, illness or injury sustained while playing at, or attending any function with, The Club. I understand that The Club carries only basic player’s insurance (provided through registration with FFV) and that it is my responsibility to arrange additional insurance cover. The Club recommends that every player takes out their own private health insurance. I also give my permission for The Club to arrange medical attention that may be deemed necessary including ambulance transport and I agree to pay for all such costs incurred ( emergency ambulance transport costs once paid can be claimed via player insurance ) The Club agrees that it will do its utmost to seek or obtain my and/or parental consent, if possible, prior to seeking medical treatment for me, but I understand and accept that it may not be possible to do so in the circumstances. The Club agrees to make every effort to contact my emergency contact, as listed overleaf, where necessary and as soon as it is practicable to do so. Agreement: I hereby apply to be registered as a player of Mooroolbark Soccer Club. I agree to abide by the rules of the Club’s Constitution and FFA/FFV codes of conduct as a player/spectator. I will abide with the clubs code of conduct regarding interactions with club officials, parents, coaches and volunteers. I am aware that The Club may use my pictorial image in club promotions/publications/social media. * *
A copy of your responses will be emailed to the address you provided.
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