Sports Ministry Registration 2023 (Over 18) Sports Ministry is an activity of the Westminster Presbyterian Church Bull Creek Inc. (WPCBC). The activities include, but are not limited to: Futsal, Badminton, Table Tennis, Pilates, Basketball, Volleyball, Bible learning and fellowship. Sports Ministry is primarily held at Melville Recreation Centre, cnr Stock Road and Canning Highway, Melville.Please enable JavaScript in your browser to complete this form.I would like to register for: *Futsal (over 18's)Badminton/Table TennisPilatesBasketballVolleyballHow did you hear about Sports Ministry?WebsiteA friendGoogle searchOtherWhats the name of your friend?Please give detailsSurname *Given Name *Gender *MaleFemaleDate of Birth *Phone Number *Email *Home Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEmergency Medical DetailsAllergiesDo you have any allergies? *YesNoSelect any allergies that apply *PenicillinBee stingsBetadinePain relief medicationFood allergiesOtherPlease list food allergies *Please list other allergies *Does you require an adrenalin pen? *YesNoPlease note, if you have anaphyaxis you are required to carry your own epipen.Does you have any medical conditions? *YesNoPlease select any medical conditions that apply *AsthmaDiabetesOtherPlease list other medical conditions *Does you need to use regular medication? *YesNoPlease list any medication that requires self-administration *Emergency Contact InformationContact person in case of emergency *Relationship to you *Emergency contact number *ConsentsI consent that WPCBC may use photos and/or video footage of me for the WPCBC website/newsletter/other publications *YesNoI authorise the WPCBC leaders/volunteers, where it is impractical to communicate with me, to arrange for medical treatment and/or an ambulance for me as deemed necessary *YesIndemnityI agree that:I will be responsible for any costs incurred on my behalf due to a medical emergency, accident or misdemeanor whilst attending Bull Creek Sports Ministry activities.I accept all reasonably forseeable risks associated with the Bull Creek Sports Ministry program, including loss or damage to personal property or personal injury sustained by myselfI confirm that this information is correct and understand that failure to disclose changed or new information will be at my own riskSignature *Clear SignatureDate *PhoneSubmit
