Futsal Fellowship Cup rego page - Westminster Presbyterian Church Bull Creek

I am/the person I am registering is *

Under 18
Over 18

My team is

Given Name *

Surname *

Date of Birth *

Phone Number *

Email *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Medical Details

Does you/the person you are registering have any medical conditions that we should be aware of? *

Yes
No

Please list medical conditions

Emergency Contact Information

Contact person in case of emergency *

Relationship to you *

Emergency contact number *

In attending Fellowship Cup activities, I undertake the following

I consent that WPC Bull Creek Sports Ministry may use photos and/or video footage of me/my child for website/newsletter/other publication purposes *

Yes
No

I authorise the WPC Bull Creek Sports Ministry leaders, committee and volunteers, where it is impractical to communicate with me, to arrange for emergency medical treatment for me/my child, (including ambulance) *

Yes

Indemnity

In attending/my child attending the Fellowship Cup activities (WPCBC Sports Ministry), I undertake the following:

I agree that I/my child will abide by the rules, guidelines and instructions given by the WPCBC Sports Ministry Leaders

I accept all forseeable risks associated with participating/my child participating in WPCBC Sports Ministry activities

I agree that I will be responsible for any costs incurred on behalf of me/my child due to a medical emergency, accident or misdemeanor whilst attending WPCBC Sports Ministry activities

Signature *

Date *

Men’s Open Futsal Fellowship Cup

Emergency Medical Details

Emergency Contact Information

Indemnity