Kedron Wavell Services Hockey Club INC.

Junior Summer Hockey 2012

Summer.hockey.kw@gmail.com

Summer Hockey is on this year!!!

Date:
Starting Wednesday 10th October and finishing Thursday 6th December 2012

Cost:

Team registration fee: $100 (non-refundable; payed in advance with registration) Balance payable before the first game on the first night of play. Players who are not currently registered with a hockey club will incur a $20 insurance fee to Hockey Queensland. (payable prior to the first game) Registration forms will not be accepted without $100 registration fee.

Wednesday Night:

U13 and U16 Teams Eight-a-side (1/2 field) Cost per Team $640 U9 and U11 Teams Six-a-side (1/3 field) Cost per Team $480
Modified indoor hockey rules apply

NEW FORMAT

Thursday Night:

Positions fill quickly so get your team/s organised early to avoid disappointment; then send your completed registration form to:
Contact: summer.hockey.kw@gmail.com

Kedron Wavell Services Hockey Club Inc. Summer Hockey 2012 JUNIOR TEAM REGISTRATION
Team/club name: _____________________________ Uniform colours: Shorts/Skirts __________________ Shirts ________________________
Players Name D.O.B Home Phone Mobile Phone Club Registered Grade played 2012

Team Manager:_________________________________ Phone:_______________________ Email:________________________________________ Mob:________________________

Note: email must be supplied as any changes to draw will be communicated via email

PLEASE NOTE: A non-refundable $100 Registration fee per team is to be paid in advance with this registration form. (registration will not be accepted without payment of team registration fee) The balance of games fees is payable before the first game on the first night of play. Any Player who is not currently registered with a hockey club will incur a $20 insurance fee to Hockey QLD (payable with balance of team fee). Registered club players are covered by insurance with Hockey QLD to December 31 st 2012.

TEAM NOMINATIONS CLOSE 4PM SUNDAY SEPTEMBER 23RD 2012 PAYMENT DETAILS
Cash Credit Card Holder Type of Credit Card Credit Card Number Expiry Date Amount authorised: Cardholders Signature
Please return completed registration form with payment to:

Cheque MasterCard

Credit Card

Visa /

_ CCV _ _____ (3 digit no) ______________________ summer.hockey.kw@gmail.com Registration fee - $100 Full Wednesday $640 Full Thursday $480

Kedron Wavell Services Hockey Club Inc.

(AFFILIATED WITH HOCKEY QUEENSLAND INC)

Member Insurance Form

O Only for summer hockey players not registered with a HQ affiliated club in 2012.

2012
This form is to be completed, signed and dated by all members over 18 (or by a parent or guardian if under 18) and then submitted with team registration. The details contained herein are required for insurance purposes.

PERSONAL DETAILS
GIVEN NAME: INITIAL: SURNAME: D.O.B

ADDRESS:

SUBURB:

STATE:

POSTCODE:

TELEPHONE: EMAIL:

HOME:

WORK:

MOBILE:

JUNIOR

I AM UNDER 18 AS AT 1ST JANUARY OF THIS CURRENT YEAR

DECLARATION
I hereby acknowledge and agree by the rules and regulations of the Kedron Wavell Services Hockey Club Inc as set out in its Constitution, By Laws, handbook, etc. I hereby agree to abide by the competition rules of the Kedron Wavell Services Hockey Club Inc. Social summer hockey competition as detailed on the Kedron Wavell Services Hockey Club website www.kwhockey.com.

.. Signature of Player or Parent/Guardian (if Under 18) ........ Name of Parent or Guardian who has signed above (Print)

. Date . Relationship to Under 18 Player

OFFICE USE ONLY

FORM SIGNED: (Date)

INSURANCE PAYMENT RECEIEVED: (Signed by KWSHC Club Official)

TEAM:

Belinda Urquhart, (Vice-President), Kedron Wavell Services Hockey Club Inc. Mobile: 0421 287 403

PAYMENT DETAILS
Credit Card Holder Type of Credit Card Credit Card Number Expiry Date Amount authorised: Cardholders Signature / CCV _________ (3 digit No.) Junior Insurance - $20 Visa MasterCard