Juniors Registration – Summer 2021-22

    Please complete all information in the below Juniors Summer 2021-22 registration form. Payment details will be emailed to you once your registration has been processed by the Registrar.

    Player Details

    First Name:
    Surname:
    Date of Birth:

    Gender:
    MaleFemale

    Address Details

    Parent/Guardian 1 Details:

    Parent/Guardian's Name:
    Relationship to Player:
    Phone:
    Email:

    Parent/Guardian 2 Details (Optional):

    Parent/Guardian 2 Name:
    Relationship to Player:
    Phone:
    Email:


    Would you like to use the Active Kids Voucher?:
    The voucher number is:


    If you have any special requests in relation to team preference please state along with your reason. (Leave blank if you have no special request.)

    PLEASE NOTE: The Falcons will endeavour to fulfill requests but cannot guarantee to do so as our priority is the creation of well balanced, competitive teams that meet RHBL guidelines.

    I have read and agree with the Five Dock Falcons Juniors Terms and Conditions and Code of Conduct.