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INTENT TO PLAY FORM FOR 2011/2012 BASKETBALL SEASON All players must complete form prior to trials

WABC uniform to be worn by current players- playing number.


West Adelaide Bearcats Basketball Club Players Name:Date of Birth: .Inc. 50 St Vincent Street, Pt Adelaide South Australia Address: . 5015 GPO Box 568, Woodville Suburb:..Postcode: ..5011 South Australia

Telephone: (H).. Parents Names

(Mobile) .... Telephone: 8 8341 1416


Facsimile: 8 8240 5132 Website www.bearcats.net.au Email: info@bearcats.net.au ABN 73 030 192 206

Mother Contact No.. FatherContact No Parents email Address required for junior players Basketball History: Current WABC player?(please circle )
.Div

Yes

Year started. Current Team U/

NEW PLAYER
Previous Experience: (Please circle) District. Social School

Name of previous Club/ Team:.. Age group:....Div: ..

Information required from New Player commencing after season has commenced
Coach who you have spoken to:.. Which Age group: . What Division:.. Boys / Girls (please circle). Yes /

Club information
I wish to play with the West Adelaide Basketball Club for the 2011/2012 season No

I agree to abide by the conditions for the West players as set down in the Parent Handbook Booklet. I understand that the Coaches and Coaching Directors will offer positions for the West teams in 2011/2012 according to overall evaluation.

Permission for Publication of Player Photographs The West Adelaide Bearcats Basketball Club will, from time to time, place photographs of players in publications and on the club website.

Photographs that are used will not include identifying information such as addresses and contact phone numbers. The club will be very careful with the information that it utilizes.

I .. give the West Adelaide Bearcats Basketball Club permission to use photographs of me/my child in the club publications and on the club website, for promotion of the club and basketball in general. Adelaide Bearcats Basketball West Club Parent/guardians signature (if player is under 18 years) Inc. Players signature (if player is 18 years or over). 5015 South Australia
50 St Vincent Street, Pt Adelaide GPO Box 568, Woodville South Australia 5011

WEST ADELAIDE BEARCATS BASKETBALL CLUB Inc


www.info@bearcats.net.au

Telephone: 8 8341 1416 Facsimile: 8 8240 5132 Website www.bearcats.net.au Email: info@bearcats.net.au ABN 73 030 192 206