Parent / Guardian Details

Parent / Guardian Name
First Name*:

Last Name*:

Phone Number (leave blank if same as the player's):

Mobile (leave blank if same as the player's):

Email Address (leave blank if same as the player's):

Parent / Guardian Address (leave blank if same as the player's)
Residential Address:

Suburb:

Postcode:

Photographing

The Association may wish to publish images of your child aged under 18 to promote Hockey and the Smarter Than Smoking Message. The publishing of your child's image will be in appropriate sporting dress with the focus on the activity of the player rather than the particular child and will avoid full face and body shots.

If you DO NOT wish to have your child's photograph displayed in public please TICK this box

Message:

Enter the code above here:

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Acknowledgment

In submitting this document, the player along with his/her parent or guardian:

1. Acknowledges that they will abide by Hockey WA's Code of Conduct (a copy of which can be found on www.hockeywa.org.au).

2. Will not in any way implicate any club, member, or official of the Bunbury District Junior Hockey Association on any social media such as Facebook or Twitter

Exies Hockey Club

Bunbury WA (Established 1932)

EXIES Junior Player Registration

Player Details

Parent / Guardian Details

Photographing

Acknowledgment