Given Name

Family Name

Day of Birth Select Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Month of Birth Select Month January February March April May June July August September October November December

Year of Birth Select Year 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993

Gender Male Female

Number & Street

Suburb

Postcode

School

Email Address

Mother's Name

Mother's Home Phone

Mother's Work Phone

Mother's Mobile Phone

Mother's Occupation

Father's Name

Father's Home Phone

Father's Work Phone

Father's Mobile Phone

Father's Occupation

Year first joined Falcons

Last Year's team

Team preference for this year

Is this your fifth consecutive year playing for the Falcons? Yes No

Known Allergies? Yes No

Medical problems? Yes No

Long term medication? Yes No

Details:

Permission to seek emergency medical treatment if required, when parent/guardian not present? Yes No

We seek permission to use photos of this registered junior player, which may be taken during games or events throughout the baseball season. No names of under 18 players will be used in conjunction with photos when published on the Falcons web site.

Permission? Yes No

Your relationship to player

I hereby declare