Coogee United Juniors
2012 JUNIOR PLAYER REGISTRATION FORM (1) PLAYER DETAILS
First Name
Middle Name
Surname
Mobile
Date of Birth
Gender M/F
School
(2) MEDICAL CONDITIONS Does your child has any medical conditions that this club needs to be aware of: No
Insert "X"
Yes, please specify
(3) PLAYING HISTORY Returning Player (From same club) Insert "X"
Previous Team:
New Player (Never played before) How did you hear about CUFC ? Transferring Player (From another club)
Previous Club:
(4) COMPETITION Age Group applying for: Boys Teams Born in
2000
1999
12's
Insert "X"
1998
13's
1997
14's
1996
15's
1995 & 1994
16's
18's
OR
Girls Teams 2000
Born in
1999
12's
Insert "X"
1998
13's
1997
14's
1996
15's
1995 & 1994
16's
18's
(5) PARENT/GUARDIAN DETAILS Main Contact First Name
Middle Name
Date of Birth
Surname
Relationship to player
Gender M/F
Phone (Home)
Phone (Wk)
Phone (Mob)
Join Coogee United Juniors on Facebook
Facebook Address Email Address
P/Code
Suburb
Secondary/ Emergency Contact First Name
Middle Name
Date of Birth
Surname
Relationship to player
Gender M/F
Phone (Home)
Phone (Wk)
Phone (Mob)
Email Address
P/Code
Suburb
(6) SIGNING By signing this form, I agree to the Terms and Conditions of Coogee United Football Club
Name
Signature
Date
(7) NOTES ***OFFICE USE ONLY*** Amount
Payment Method Cash Cheque
C/C Eftpos
Siblings: Administrator:
$
:00
FFA No
Receipt No Date Received
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