Seniors Winter 2019 Registration Form


Please complete all information in the below Seniors Winter 2019 Registration Form. Payment details will be emailed to you once your registration has been processed by the Club Registrar.

Player Details

First Name:
Surname:
Date of Birth:

Gender:

MaleFemale

Contact Details

Mobile:
Email:

Address Details

Playing History

Have you played baseball at adult level at a club other than Five Dock?: YesNo

If yes, please list the last club, grade and year that you played at an adult level:

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.

Personal

Occupation:
Registering for discount: Full-time studentUnemployedPensioner
Name of school or other educational institution if registering as a full-time student:

PLEASE NOTE: Proof of student / unemployed / pensioner status may be required to enable discount.

Emergency Contact

Name:
Mobile:

I have read and agree with the Five Dock Falcons Seniors Code of Conduct.