Kingsbury Comets Basketball Club Inc.
Application for Membership (New Player)
Date of Birth (bring copy of Birth Certificate)
Father’s Name Mobile
Mother’s Name Mobile
Have you previously played basketball for another Club? Yes or No
If Yes, what Club? Grade Played
If DVBA Affiliated Club, do you have a clearance from that Club? Yes or No
Permission to allow photo and first name of child on Comets website Yes or No
To ensure the ongoing welfare of the club, parents/guardians are invited to assist.
Ask any committee member how your skills may be of help.
We very much appreciate your input, be involved it’s your club too.
Registration Fees: Fee per season (2 seasons per year) per child: $50 Family (2 or more children): $140
Due to Public Liability issues fees must be paid before a child can play.
Match payment of $6 per game payable each week to cover DBVA fees. Payable to team manager on game day.
D.V.B.A INC. BOYS / GIRLS
BOYS / GIRLS
Club: __________________________________________ Club: __________________________
Name: ______________________________________________________________________ Surname: _______________________
Surname Given Names
Address: ______________________________________________________________________ Given: __________________________
______________________________________________ Phone: _________________________ Address: _______________________
Birth Date: _________________________________ Proof: ___________________________ _______________________________
I DECLARE THAT AS A REGISTERED PLAYER WITH THE DIAMOND
VALLEY BASKETBALL ASSOCIATION INC. TO ABIDE BY THE RULES AND
REGULATIONS OF THE ASSOCIATION AND IN ACCORDANCE WITH THE
LAWS OF BASKETBALL AUSTRALIA. Signed: _________________________
__________________________________________ ___________________________________ Ph No: _________________________
(Club Secretary) (Player Signature)
(Commissioned Officer) (Date) REG No: ____________________
Parents/Guardian Consent: (refer to club website for Privacy Statement)
I hereby give permission for my child to participate in training and play Basketball for Kingsbury
Comets Basketball Club Incorporated. I will not under any circumstances hold the Club liable for
any accident or injury that may occur. In the event of any injury or illness, where it is
impracticable to communicate with me, I authorise a representative of the Club to procure, on
my behalf, such medical or other assistance as my child may require. I accept responsibility for
payment of any expenses incurred by the aforesaid treatment.
I further agree that my child and myself as a parent/guardian member will abide by the Rules of
the Kingsbury Basketball Club Inc. and the appropriate codes of conduct as displayed at the
Kingsbury Comets hall.
Parent’s / Guardian’s Signature: _________________________________________ Date: ________________________
Parent’s / Guardian’s Name: _____________________________________________
OFFICE USE ONLY
Player Name: _____________________________________________________________________________________
Fees - Registration: - Yes / No Amount Received: $ Balance: $
- Uniform: - Yes / No Amount Received: $ Balance: $
Team/Age Group: ______________ Singlet No: _____________ Jacket No: ______________
Is Clearance required from another club? - Yes / No If so, have we lodged it? - Yes / No
Clearance No: ______________ DVBA Registration No: ____________________
All Data entered on Database by: ___________________ Data Base ID No: ________ Date: ________________
Checklist - (tick & date each entry)
□Coach: _________________ □Sect: _________________ □Uniform: ___________ □Treas: ___________________