Registration Register to PlayName* First Last Phone*Email* Address* Street Address City State Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Participant Name* First Last Participant Date of Birth* Date Format: MM slash DD slash YYYY Age*Does the participant suffer from any medical conditions or have any health conditions the coach should be aware of? If so, please specify:How to Pay Commonwealth Bank Australia BSB: 063-188 Account: 10473571 Reference: Your Last Name Would you like to apply for scholarship due to hardship?* YES NO Program location* Port Melbourne Maidstone Cranbourne Consent* I Consent to the Terms and Conditions of Registration.This form is intended to ensure that you (the parent/guardian) provide informed consent for your child/children to participate in the activity organised by the City of Port Phillip and One Ball, on the terms and conditions set out in this form. This form contains terms which are of legal force and effect. EFFECT OF THE CONSENT FORM: Without limiting the effect of the form, it provides in summary that; You consent for your child/children to participate in the activity on the terms set out by the City of Port Phillip (Council) and the program facilitator, One Ball. 1. You agree for your child/children to participate at their sole risk. 2. If your child/children are injured or suffer a loss during the activity you/they may not be able to take any action against the Council, its employees, volunteers, subcontractors and agents. Council has no liability from risks associated with this recreational participation program. Further, the Council has no duty owed to participants engaged in this activity. 3. If your child/children cause injury or loss to a third party during the activity and the third party takes action against Council, you agree to indemnify (reimburse) Council for any cost or loss that Council may incur as a result. 4. You authorise Council and One Ball to organise and consent to any medical treatment that your child/children may require during the activity, at your own cost. IMAGE CONSENT: The City of Port Phillip and One Ball may take photos and use images of participants in communications and marketing material. I understand that the images may be used for promotional purposes and may be printed or published online. I understand that the images will be kept on file by the City of Port Phillip and One Ball and may be reproduced a number of times in communications and marketing material. I understand that there will be no financial or other remuneration for taking or use of the images. I acknowledge that the images are the property of the City of Port Phillip and One Ball, and that Council and One Ball will not use these images in a manner that may be deemed adverse or defamatory to me, or for any political or commercial gain.