Registration

Register to Play
Name*
First Last
Phone*
Email*
Address*
Street Address City State Post Code 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.

Registration

Register to Play