Waverley Victory FC

2017 Registration Form

FAMILY DETAILS - Please use BLOCK Letters
Parent (Mother) Guardian
First Name

Surname

Home Phone

Mobile Phone

Email
Are you current Melbourne Victory Members

Occupation

No

Parent (Father) Guardian

First Name

Surname

Home Phone

Mobile Phone

Email
Occupation

Are you current Melbourne Victory Members

Yes

PLAYER DETAILS
FIRST PLAYER

FFV No:

First Name
Male / Female

Surname

Male

DOB

2016 CLUB (If Not WVFC)

Melbourne Victory Member

Team (Age)

No

Use of your child's photo in Club Social Media

No

School attending?
SECOND PLAYER* (10% SIBLING DISCOUNT)
First Name
Male / Female

FFV No:
Surname
DOB

Female

2016 CLUB (If Not WVFC)

Melbourne Victory Member

Team (Age)

Yes

Use of your child's photo in Club Social Media

No

School attending?
Waverley Victory FC may use personal information collected to provide you with information about products, services and promotions
offered by our sponsors. Please notify WVFC if you do not wish to be notified about the products, services or promotions offered by our
sponsors.
* Where a family has 3-5 players attending WVFC please use a new form for additional child (s)

EMERGENCY CONTACT DETAILS - (Primary Contact Person)

Name:

Phone Number:

If you are new to the club - how did you learn of Waverley Victory FC?

PLAYER MEDICAL DETAILS

FIRST PLAYER
For club information, please detail any medical condition
and/ or allergies that the club and/or the coach should be
aware of.

Please detail any medications required before/ after a

match or training session that the club should be aware of.

SECOND PLAYER
For club information, please detail any medical condition
and/ or allergies that the club and/or the coach should be
aware of.
Please detail any medications required before/ after a
match or training session that the club should be aware of.
I have read the WVFC Players & Parents Code of Behavior, WVFC Conditions and agree to comply with its direction &
will ensure my child does the same.
Player 1 - Name:
Players Signature:

Date:

Player 2 - Name:
Players Signature:

Date:

Parents Name:
Date:

Parent Signature:
Parents Name:
Parent Signature:

Date:

CLUB USE ONLY - Fee structure - Saturday U5 to U8 - $675.00 Sunday - U9 to U11 - $640.00 U12 Upwards $750.00
Player Fees: $

Date Paid:

10% Sibling Discount: $

Receipt Number:

1.5% Credit Card Surcharge: $

Date Banked:

Total Amount Due :

Payment Type: - CASH / CHQ / EFT / DIRECT DEPOSIT

FIRST PLAYER

SECOND PLAYER

Checked

SELF REGISTRATION

SELF REGISTRATION

PLAYING SHIRT SIZE

PLAYING SHIRT SIZE

SHORT SIZE

SHORT SIZE

SOCKS SIZE

SOCKS SIZE

TRACK TOP SIZE

TRACK TOP SIZE

TRACK PANT SIZE

TRACK PANT SIZE

DEPOSIT / PAYMENT - $
PAYMENT OWING - $

Checked