U12 Competition Registration

Commencing: Sunday 1st November 2015 to 22nd November - FOUR WEEKS

12.00-2.00pm Albany Creek Leisure Centre, Explorer Drive, Albany Creek.

Boys & Girls born 2004 and younger who are NOT playing in the U13 Saturday Competition. Enter a team of 6 or more or nominate as an individual. Experienced coaches will provide a skills session each week followed by a game.

Cost is $65 per player, including registration and insurance, and pool entry for players and spectators.

REGISTRATION FORM

Player Name

Date of Birth

Gender

Male Female

Have you played Flippa Ball or Water Polo before?

Yes No

If so where?

Have you registered with another waterpolo club for the 14/15 season?

Yes No

If so which club?

Email Address

Emergency contact mobile no

Emergency contact name

Please choose one of the following

I am registering as an individual player and would like to join a team
I am a member of a team (Teams must be a minimum of 6 players)

Name of Team

PLEASE NOTE: Payment MUST BE MADE with registration to ensure confirmation. Also, please note there are no part payments or refunds for sessions not attended.

NORTH BRISBANE WATER POLO CLUB INC.
BSB: 124-001
ACCOUNT: 10401503
Reference: (SURNAME)U12

If you do not have access to internet banking, you can make a deposit at any Bank of Queensland branch using the above deposit details. Thank you.

I confirm that I have made payment for this player via direct bank deposit

Any queries, please contact Jane at u12@polobears.com.au

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