Office use only:

Name: ______________

Age group:
___________

Payment:

Gold Coast Celtics Basketball Club Inc.

____________

Date:_______________
Registration for GCJBL 2016 Summer Competition

Commencing Friday 7 October – 10 December

This form is to be completed by the parent/guardian and must include all information.
Each player must complete a separate form. Once completed please email to Gold Coast Celtics
Basketball Club – email – celticgc@bigpond.net.au

Players Surname (Please circle) Male Female

Players First Name

Date of birth

Address

Suburb

Parent/Guardian 1 Name Occupation

Parent/Guardian 1 mobile Occupation

Parent/Guardian 2 Name

Parent/Guardian 2 Mobile

Primary email address

(Please ensure this is correct as it
is our primary communication
source) I would like to receive newsletters and text messages yes / no

Has your child played basketball before?

If Yes, for which club? (If you are transferring from
another club you must complete a "GCCRBA Club
Transfer Form" available from the Gold Coast
Basketball website under "forms")
What school does your child attend?

Does your child have any medical conditions that we should be aware of?
If so please provide further information below.

I hereby authorise the staff and volunteers of GCCBCI, to act for me according to their best judgment in any emergency requiring medical
attention and I agree to hold GCCBCI and its staff and volunteers harmless and indemnify them in respect of anything so done. In addition, I
hereby waive and release GCCBCI from any liability for any injury or illness sustained or experienced whilst at trainings or games whether
arising through the negligence or breach of contract of them for any other cause. I understand that public liability and professional indemnity
insurance is held by GCCBCI but subject to the terms of the relevant policies and that personal injury insurance is held for financial participants
appropriately registered with GCCBCI through a member association of GCCRBA but only for the duration of the program, for the purpose of
playing basketball and actively engaged in that sport. I also understand and agree that GCCBCI has the right to use for publicity and
advertising purposes photographs of players and participants taken at trainings, games or programs.
Signed:____________________________________________Date:__________________________________________________
Registered $150 paid directly to Celtics Basketball Club which includes 10 weeks of Game Fees, Team
Players Winter Nomination and Training fees.
Competition This can be paid by:
2016
DIRECT DEPOSIT:
Account Name: Gold Coast Celtics Basketball Club Inc.
BSB: 124 001
Account Number: 218 23 183
(Please use your child's name as the reference)

Or

EFTPOS, VISA or MASTERCARD at any ot the Summer Competition Sign Ons.

(There will be no payment plans offered to players for the Summer Competition)

Unregistered $195 including the following

Players
$150.00 paid directly to Celtics Basketball Club which includes 10 weeks of Games Fees,
Team Nomination and Training Fees.

PLUS

$45.00 paid online to Gold Coast Regional Basketball Association

To pay Online Registrations go to www.goldcoast.basketball.net.au – follow the
instructions

Uniforms All new players to Celtics Basketball Club for the Summer Competition can:
1. Purchase a new uniform or
2. Borrow a loan uniform from the club

PLEASE NOTE:
There will be no direct debit payment plans offered for the Summer Competition, however we do not want a
child to miss out on playing because of financial reasons.
If you would like to discuss payments further please contact Christine Ward on 0433 283 332 between
6.00pm – 8.00pm week nights Or email celticgc@bigpond.net.au

GC Celtics relies heavily on volunteers; at times we cannot supply each team with a coach. Teams are
formed by the club and if we do not have a coach for that age group/team we ask that a parent
volunteer to coach. Celtics will provide training each week for all players and we encourage coaches to
come to training to learn drills and skills.

Registration checklist
My child is registered with Gold Coast City Regional Basketball Association and Celtics Basketball Club
Inc
I have filled in all details on this form and signed the indemnity/photograph clause
I have paid Celtics fees into the Celtics Bank Account.
Once the checklist is complete please proceed to email this registration form to GC Celtics Administration
**Registrations and respective payments must be received by Friday 24 September 2016

If you have any queries or wish to discuss further please contact Tracey Want on 0433 172 929 or Christine
Ward on 0433 283 332 between 6.00pm – 8.00pm weekdays or alternatively email celticgc@bigpond.net.au

PLEASE BE REMINDED: that all our volunteer committee members work full time and your enquiries may not
be responded to immediately.