LEICHHARDT TIGERS JUNIOR SOCCER CLUB INC.

Lambert Park - Cnr Marion and Foster Streets Leichhardt NSW 2040
Email: admin@apiatigers.com Website: www.apiatigers.com
Infoline: 02 9572 6888

2016 Registration Form

Surname: . First Name: .
Address: Suburb:Post Code:..
D.O.B:

Team & Division Last Year:..

Mobile:: Email:.

Age Groups:
Nursery (3s - 5s) Intra club games
Juniors (6s - 10s) Non-competitive
Juniors (11s 16s) Competitive
Adult (17s 21s, AAM, AAW, O35s, O45s)

Fees:
$210.00
$310.00
$350.00
$430.00

Early Bird Discount Fees

(October to 31 Dec 2015):
$160.00
$260.00
$300.00
$390.00

I, the undersigned, approve of this application and in doing so agree that the Leichhardt Tigers Junior Soccer Club Inc and its
officers and servants are free and clear of all responsibility whatsoever in the above mentioned activity for any loss, injury or
illness during the applicants participation in this activity. In the event of any injury or illness to my child, I hereby give consent in
arranging any medical treatment that may be required.
Medical information - Any child entering the competition with a medical problem must bring a letter from his/her doctor regarding
treatment of the condition.

Signature of Player/Parent or Guardian: Date:...............

This application form together with your FEE is payable to:

The Leichhardt Tigers Junior Soccer Club Inc - PO Box 225 Haberfield NSW 2045
Payment details: (please tick)
Cheque

EFT

Direct debit

Visa*

MasterCard*

Card number:

Expiry Date: ____/_____

Verification No:

Amount $: .Card Holders Name:Signature..

(* a 3% surcharge will apply to credit card payments)

If paying by cheque: or Direct Debit: National Australia Bank Limited

Account: Leichhardt Tigers Junior Soccer Club Inc
BSB: 082 171 ACCOUNT No: 58471 6730 Reference: Child name + team
Cancellation policy and refunds:
Please make sure all relevant information regarding registration has been carefully read, and fully
understood, before signing below, and that conditions are accepted. Upon registration the full amount is
payable and, once fees have been paid, there will be NO REFUND.
De registration will need to be in writing and addressed to the Club through the Convenor.
The Control, Conduct, Administration, and Policy on all activities relating to a registered Leichhardt Tigers
Junior Soccer Club player is, at all times, at the absolute discretion of the Clubs Board of Management.

Signature: