New Player Sign Up

Enter a password

Password

Confirm Password

Main details

First Name * Surname * Date of Birth (DD/MM/YYYY) Parents/Caregivers Address

Email * School Phone (Home) Phone (Mobile) Gender *

Male
Female

Volunteer Support

The Club functions through the work of volunteers and each team must provide a Coach and Manager

Please Tick the appropriate boxes and enter the name of the volunteer in the box below

Coach Manage Assist Coordinator/Convenor

Other

Special Events in the Club

I wish to trial for the division 1 team (9,10,11,12,13 Grades ONLY)

registration newsletter- see registration newsletter for your trial date and time

I wish to attend

Team Composition

Where possible we will place players togther with a requested team mate.
Please keep your requests to a max.of 3 players

This is not applicable to players who trial or gain selection to the top division 1 teams

Please enter details below.

Club Sponsorship

I acknowledge that in signing this form, the Junior Club and/or Junior Club sponsors may send me promotional material from time to time.

The Junior Club coaching programme benefits from sponsorship funds.

Sponsorship

Registration Fees

Subscriptions to be paid by 28-Feb-2010

The Online Registration Amounts are:

PDP per player (5-7yr)            $ 60.00
8 - 13th grade per player       $ 80.00
Girls Sunday league $ 80.00
Girls Saturday & Sunday $120.00
Maximum per family               $160.00

Donation amount $..

Westpac : 03 0578 0923426 05
Name : ISLAND BAY UTD JUNIOR SOCCER

Please indicate players surname and year of birth in the 'FIRST' field when making internet payment for Payee. ie: Soprano 2001
For multiple player payment list surname and number of children ie: Soprano x3

Amount

Method

Internet Banking or Bank Deposit
Cash
Cheque

Date Payment Sent

(DD/MM/YYYY)

Bank Code

e.g. 01

Branch Code

e.g. 0101

Disclaimer

The Island Bay Football Club maintains a database of members' information for the purpose of administration
of the Club and our affiliated organisations.

This information will not be provided to any other unauthorised person or organization.

By completing this registration form, players and parents confirm that they will abide by the NZ Football Code of Conduct. see www.capitalfootball.org.nz

Island Bay United Junior Football Club

Please indicate players surname and year of birth in the 'FIRST' field when making internet payment for Payee. ie: Soprano 2001For multiple player payment list surname and number of children ie: Soprano x3

Please indicate players surname and year of birth in the 'FIRST' field when making internet payment for Payee. ie: Soprano 2001
For multiple player payment list surname and number of children ie: Soprano x3