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 |  | North Thuringowa Junior RLFC 2012 Registration Form
Dear Parent,
Please supply the information requested below and bring this form to sign-on day 28th January 2012 and hand it to the club registrar at the
club house as soon as possible.  However please be aware that for any player to be recognised as being eligible to play their first game must first:
 | 1 - Return this form signed by their parent or guardian
 | 2 - Have paid the full amount of registration fee for 2012
 | 3 - Parents or guardians must sign the QRL registration form (available on registration day or training days)
ALL THE ABOVE ITEMS OF REGISTRATION MUST BE COMPLETED BEFORE IT IS DEEMED YOUR CHILD IS REGISTERED AND ABLE TO PLAY.
 |  |  | THIS MEANS NO PAY NO PLAY.
Please note the following minimum deposits (Minimum payment U6's $50 and  U7's to U16's $75) must be paid on sign-on.
The full amount must be paid before the first T&DJRL trial game for your child to participate.
This measure has been forced upon our club due to difficulty of obtaining registration fees in the past years and the club now being registered for GST.
Any player who has outstanding fees from the 2011 season, will not be eligible to train or play their first game of the 2012 season until all the fees outstanding from 2011
fees have been paid.
Please note any player with outstanding fees wanting to transfer to another club will not be released to play for that club until all outstanding
fees are paid.  Queensland Rugby League (QRL) Rules and Regulations.
If you have any queries, please don't hesitate to contact the club house on training days or ([NAME] [PHONE])
THANK YOU, YOUR COOPERATION IS APPRECIATED
Please Print all the information below
2011 Age Group |  |  | 2012 Age Group________
Childs Surname: |  |  |  |  |  |  |  |  | Birth Certificate No.
Childs Christian | Names: |  |  |  |  |  | D.O.B
Residential
Address:
Suburb:
Postal |  |  |  |  |  |  | Emergency Contact:
Address: |  |  |  |  |  |  | Phone #:
 |  |  |  |  |  |  | Relationship:
Parent Phone Number:
Parent Mobile Number:
Parent [NAME]:
Each player will receive a club sponsored polo shirt following FULL payment of their registration fees and receipt of club polos.
Players signing on after the shirts have been allocated will only receive a polo shirt if stock permits.
Fee Structure for 2012 |  | NO PAY - NO PLAY |  |  | Your Childs Polo Shirt size
 |  |  |  |  | Your Childs Shorts Size
The fees for 2012 are: |  |  |  |  | Your Childs Sock Size
1st Child |  | 170
2nd Child & subsequent children |  | 160 |  |  | Please circle the number of [NAME] players in family
 |  |  |  |  |  | 1  - 2  - 3  -  4
The only exception to this is U6's, where their fee is $100
I agree that during the period/s of the aforesaid competitions in which my child participates, and during such travelling and other acivities as may be
deemed necessary, my child shall be under the direction of the person/s duly appointed by the club in charge of the team/s in which they are included.
I further agree to meet the costs of any illness, accident or unforeseen circumstances which may occur during the periods of the activities in which
my child participates and during such travelling and other activities as may be deemed necessary.  I also give my concent for my child to travel by bus
or private car when necessary, to attend any games.  I hereby authorise the obtaining on my behalf and medical assistance my child may require in
the event of an accident or illness.
**  I agree that the North Thuringowa Rugby League Club can use any photo, photo's or video of my child at training, playing rugby league and
participating in any club activity or event for the purpose of promoting the club (any material used will be in accordance with child safety).
On signing of this form I acknowledge that I have read and understand the information contained in this form.
Parent/ Guardian
 | Surname (Last name) |  | [NAME] |  | Signature: |  |  | Date:
 |  |  |  |  |  | For Office | Receipt No's | Amount/s Paid | Amount owing
 |  |  |  |  |  | use only
Are you willing to volunteer during the season at the club house during training, home games & other functions? YES/NO               Email address: ________________________________________