2011 PIC NETBALL CLUB MEMBERSHIP / REGISTRATION

If you wish to play for PIC NETBALL CLUB please complete the registration form below. If you experience any difficulties please email secretary@picnetball.org.nz

PIC TEAMS FOR 2011

We anticipate we will have four teams this season. Two in Premier 1, one in Premier 2 and one in a Senior Grade.

MEMBERSHIP REGISTRATION

To register please read and complete the following sections: PERSONAL DETAILS, OTHER DETAILS, READ THE DECLARATION then REGISTER.

PERSONAL DETAILS

MEMBER DETAILS

Please fill in your details below.

FIRST NAME *

LAST NAME (@ BIRTH) *

PREFERRED NAME

GENDER

OTHER ETHNICITY

STREET ADDRESS

HOME PHONE *

WORK PHONE

MIDDLE NAME

MARRIED NAME *

DOB *

ETHNICITY

OCCUPATION

SUBURB

MOBILE *

eMAIL

* MANDATORY INFORMATION

Ensure the list of mandatory information has been filled in, this information is required to enable you to register

First Name, Last Name or Married Name, Date of Birth, Home Phone Number or Mobile Phone number

OTHER DETAILS

TRIALING DETAILS

Players must attend at least two out of the three trial dates, of which one must be the last trial date, to be eligible for selection into a team. If you are unable to attend either trial 1 or 2, please email secretary@picnetball.org.nz at least 24 hours before the trial starts.
All aspects of play will be looked at during the trials to determine which team you are selected for i.e. warmup, fitness, skill, player combinations, attitude, leadership and team dynamics etc. All teams will be announced on Saturday, 5 March 2011.

Select the Grade/s you wish to Trial for:
PREM 1 / PREM 2 / SENIOR

Select the preferred position/s you wish to Trial for:
1ST CHOICE / 2ND CHOICE / 3RD CHOICE

PREVIOUS PLAYING HISTORY

Please supply your previous playing history by naming the last club you were registered with, grade and position/s you played in the box below.


ADMINISTRATION DETAILS

If you are available for an adminstration role please tick appropriate box below.

I am available for:
ADMINISTRATION / COACH / TEAM MANAGER

UNIFORM DETAILS

In 2011 the PIC netball uniform will include a tracksuit which will be purchased by the player for $85.00. The tracksuit will belong to you.
The playing uniforms are on lease at a cost of $45.00 for the 2011 playing season only.

Please indicate uniform sizes you require:
TRACKSUIT SIZE / UNIFORM SIZE

DECLARATION

Netball WELLINGTON REGION declaration

  1. The details I have provided are true and correct. If they change I will notify the Netball Centre, the Regional Entity or Netball New Zealand (NNZ), in writing, as soon as possible.
  2. I understand that in registering as a member of the Netball Centre, I become a member of the Regional Entity and NNZ. I agree to be bound by the constitutions, regulations, policies, manuals, guidelines and reasonable directions of those organisations.
  3. I understand that there are inherent risks of danger and injury in netball. I agree that Netball Centre, Regional Entity and NNZ are absolved from all liability arising from injury or damage arising out of my participation in any activity.
  4. I release, discharge and indemnify the Netball Centre, Regional Entity and NNZ from all proceedings, claims, demands, losses, damages, penalties, costs and expenses arising from or in connection with my participation in netball.
  5. If I play or umpire netball, I believe I am medically and physically fit and able to participate. If I am injured or ill, it is my responsibility to inform my coach and my team and take such steps as a medical practitioner recommends.
  6. I agree that the personal details on this form will be collected by my club or school, the Netball Centre, the Regional Entity and NNZ in accordance with the Privacy Act 1993 for the purposes of:
    1. processing this application and administration of the database including disclosure of information on the database between the organisations;
    2. enabling the organisations to carry out their various functions under their respective constitutions, regulations and policies;
    3. complying with the law;
    4. communicating with me and providing information relating to my role in netball; and
    5. enabling authorised sponsors to provide me with promotional and marketing material, unless otherwise indicated.
  7. I am entitled to have access to and correct my personal information.
  8. I agree to being photographed, filmed, videoed or have my image recorded, and that the Netball Centre, Regional Entity and/or NNZ may use such imagery in connection with the promotion of netball. I am entitled to request access to such images and to take copies of them at my cost.

REGISTRATION

To REGISTER your details, you must agree to the declaration as specified above.

I will accept promotional/marketing material (optional).
I have read and accept the declaration defined above (Mandatory) .
click the REGISTER button to register your details