Waverley Little Athletics - 2007 Registration Payment Form

Welcome to WAVERLEY Little Athletics

2007 Online Registration - for previous Waverley members only

If you have not been involved at Waverley Little Athletics before, please come down and visit our magnificent facilities - on one of our registration days (Sat, 8th Sep 2007 or Sun, 16th Sep 2007) between 10am and 12noon or a competition day (starting on Sat, 6th Oct 2007), prior to making a commitment to register your children.

This season we have unfortunately had to increase our fees to cover the cost of having a regular qualified "first aid" person present at all times during our competitions. Fees are as follows from October :

Fees:	1st child $110	These fees cover the Summer Track & Field season as well as the Winter Cross Country Season (if you wish to participate in that) WLAC also pays your entry to participate in all Relays (Mentone, Regionals & States).
	2nd child $100
	3rd child $90
	4th child $80

Athlete Details:

(Please fill in all cells) (DC - Double Click Cell to copy Athlete1/Parent1 details)

	Athlete # 1	Athlete # 2	Athlete # 3	Athlete # 4
First Name:
Surname:		DC	DC	DC
Date of Birth:
School:		DC	DC	DC
Medical Info (alergies etc) :
Gender:	Boy Girl	Boy Girl	Boy Girl	Boy Girl
Permission to seek medical treatment if needed:	Yes No	Yes No	Yes No	Yes No
Do you have Ambulance Cover?	Yes No	Yes No	Yes No	Yes No
Doctor Name:		DC	DC	DC
Doctor Phone:		DC	DC	DC


Parent/Gardian Information
	Parent # 1	Parent # 2
First Name:
Surname:		DC
Occupation:
Phone (home):		DC
Phone (mobile):
Postal Address:
Suburb:		Postcode:
Email (highly recommended for weekly updates):
Any comments you wish to make:

If you are unable to fulfil duty requirements, please tick box to pay the $50 levy:

Total Payable (including a small Credit Card Fee): $113.00

Please read the Parent Duty Agreement & Privacy Statement here - prior to acceptance of this form

I have read and understood the above declaration.
As parent(s)/guardian(s) of the named athlete(s), I/we hereby acknowledge
the above and verify that all details on this form are true and correct. Yes No

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