Registration Form 24/25

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Player Name

First

Last

Gender:

Male
Female

Full Address:

Mobile Phone Number:

Email:

Date of Birth: (dd/mm/yyyy)

Membership Catagory:

Junior Parent/Guardian parent Name + Surname:

Junior Parent/Guardian Mobile Phone Number:

Junior Parent/Guardian Email:

Junior Parent/Guardian Volunteer as:

of Berwick representatives

Previous Berwick Member:

Yes
No
Previous club (If Applicable)

Emergency Contact name:

Emergency Contact Mobile Number:

DECLARATION I certify that the details provided on this application are correct. I hereby release the Berwick City Cougars Baseball Club Inc; it’s officials, coaches or representatives from any claim, demand or proceeding or liability whatsoever arising directly or indirectly from any damage or injury suffered by a player which occurs during or associated with the conduct of activities of the club. I hereby agree with these conditions and any Rules of the club including the relevant Code of Behaviour. I hereby authorise Berwick City Cougars Baseball Club Inc. or its officials or representatives to provide or seek any medical treatment (including calling an ambulance) deemed necessary in the event of an injury to the player described on this form. I acknowledge that senior players are required to umpire Junior and Women's games on a roster. I hereby allow Berwick City Cougars Baseball Club Inc, its officials or representatives to take photographs or video of the membership for demonstrational or promotional purposes on club social media platforms. (If member is under 18, signed on their behalf by a parent/guardian)

Agree
Disagree