Please Make Sure You Fill In The Form Below

 

Registration & Player Information

Please choose a program/s *
Saturdays @ The Lights Community & Sports Centre
Player Name *
Player Name
Date of Birth *
Date of Birth
Address *
Address
Medical Information *
Are you an existing Powerchair Football player? *
Do you have use or have access to a mobility aid / wheelchair? *
Do you have the modifications on your mobility aid / wheel chair for Powerchair Football ie. bull bar? *
Do you have access to the NDIS? *
Type of Plan *
Emergency Contact (Parent, Guardian, Carer, Support Worker) *
Emergency Contact (Parent, Guardian, Carer, Support Worker)
Address
Address
I Give Permission For One Culture Football To Use Any Photos/Videos Of Me/Player For Promotional Purposes *
Code of Conduct: I will practice good sportsmanship; I will act in ways that bring respect to the players, volunteers, spectators and coaches; I will not use bad language; I will not swear and insult other people; I must not fight with other players, volunteers, spectators and coaches; I will not make inappropriate or unwanted physical or verbal advances on others. I understand that if I do not obey this Code of Conduct, I may not be allowed to participate.
Consent to Participate I give authorisation to ONE CULTURE FOOTBALL LTD to administer first aid or contact medical assistance if required. I hereby agree that ONE CULTURE FOOTBALL LTD and any nominated staff or volunteers shall not be deemed responsible or liable in any way for any injury or loss of personal belongings whilst engaging in a program or event. I fully understand these consents.