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Registration Form
Family Details
Parent first name
*
Parent last name
*
Do you have a health care card?
*
--None--
Yes
No
Unknown
Email
*
Mobile
*
Example: 04xxxxxxxx
Post code
*
Child/Player Details
Child's first name
*
Please enter your child's preferred name
Child's last name
*
Child's birthdate
*
Gender
*
--None--
Girl
Boy
Prefer not to say
Does your child have medical conditions we should know about?
*
--None--
Yes
No
Please let us know
Example: Asthma, Epipen, Injury
Please choose where your child would like to play
*
--None--
Port Melbourne
Cranbourne
Maidstone
In Case of Emergency please contact
Emergency contact name
*
Emergency contact number
*
Example: 04xxxxxxxx
How did you find this program?
*
--None--
Social media
Referred from a social worker
Council website
At school
Newsletter
Other
We will add you to our newsletter list, but you can opt out at any time.
I consent to the
Terms and conditions
of registration.
*
If you wish to register more children to play from your family you will be able to do so after you confirm this page.
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