Name *

First Name

Last Name

Date of Birth *

Month Day Year

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender *

Male

Female

Has your child played basketball before? *

Yes

No

Has your child played Rep basketball before? *

Yes

No

Do you accept photo permissions for Cannons social media usage? *

Yes

No

Parent / Guardian Name

First Name

Last Name

Do you have a Fair Play Voucher? *

Fair Play Voucher information: www.qld.gov.au/recreation/sports/funding/fairplay If you DO have a voucher, please contact cannonsbasketball@gmail.com and pay via bank transfer.

Yes

No

Is player registered with South West Metro Basketball Association? ALL players must have this insurance registration. *

If not yet registered, please visit https://basketball-registration.worldsportaction.com/userRegistration?organisationId=5b1b27d5-f610-4d92-b699-0a7e1408638f&competitionId=9121f102-3088-414a-aadb-32b30bf3dedf information and register as soon as possible. Players will not be able to play without this registration.

Yes

No

Player Declaration & Parent / Guardian Declaration *

I declare the information provided in this registration is true and correct. Parent / Guardian Declaration: - I am over 18 years of age and the legal parent / guardian of the player I am registering. - I agree to pay the fees required with this registration by the due date. - I have read and agree to abide by the BQ Code of Conduct and Cannons Southside Inc. Constitution.

Agree