Player Details:

Title :	Mr Mrs Miss Ms Dr Prof
First Name :	*
Middle Name :	Please enter a middle name if you have one
Last Name :	*
Preferred Name :
Date Of Birth :	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year
Male / Female :	Male Female *
Insurance Status :	Select Status Student Non Student
Country of Birth :	Australia United Kingdom (UK) United States of America New Zealand ------------------------------------- Afghanistan Albania Algeria Andorra Angola Antigua & Barbuda Argentina Armenia Austria Azerbaijan Philippines Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo (Dem. Rep. of ) Congo (Rep.) Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Phillipines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts & Nevis Saint Lucia Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia & Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Vincent & the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Tajikstan Tanzania Thailand Togo Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe
Nationality :	Australian New Zealander British American --------------------------------- Afghan Albanian Algerian Andorran Angolan Antiguans Argentine Armenian Austrian Azerbaijani Bahamian Bahraini Bangladeshi Barbadian Belarusian Belgian Belizean Beninese Bhutanese Bolivian Bosnian Herzegovinian Batswana Brazilian Bruneian Bulgarian Burkinabe Burundian Cambodian Cameroonian Canadian Cape Verdian Central African Chadian Chilean Chinese Colombian Comoran Congolese Congolese Costa Rican Ivorian Croat Cuban Cypriot Czech Dane Djibouti Dominican Dominican East Timorese Ecuadorean Egyptian Salvadoran Equatorial Guinean Eritrean Estonian Ethiopian Fijian Finn French Gabonese Gambian Georgian German Ghanaian Greek Grenadian Guatemalan Guinean Guinea-Bissauan Guyanese Haitian Honduran Hungarian Icelander Indian Indonesian Iranian Iraqi Irish Israeli Italian Jamaican Japanese Jordanian Kazakhstani Kenyan I-Kiribati North Korean South Korean Kuwaiti Kyrgyz or Kirghiz Lao or Laotian Latvian Lebanese Mosotho Liberian Libyan Liechtensteiner Lithuanian Luxembourger Macedonian Malagasy Malawian Malaysian Maldivan Malian Maltese Marshallese Mauritanian Mauritian Mexican Micronesian Moldovan Monegasque Mongolian Moroccan Mozambican Burmese Namibian Nauruan Nepalese Dutch Nicaraguan Nigerien Nigerian Norwegian Omani Pakistani Palauan Panamanian Papua New Guinean Paraguayan Peruvian Filipino Pole Portuguese Qatari Romanian Russian Rwandan Kittian and Nevisian Saint Lucian Samoan Sammarinese Sao Tomean Saudi Senegalese Serbian Montenegrin Seychellois Sierra Leonean Singaporean Slovak Slovene Solomon Islander Somali South African Spaniard Sri Lankan Sudanese Surinamer Swazi Swede Swiss Syrian Taiwanese Tajik Tadzhik Tanzanian Thai Togolese Tongan Trinidadian Tobagonian Tunisian Turk Tuvaluan Ugandan Ukrainian Emirian Uruguayan Uzbek Ni-Vanuatu Venezuelan Vietnamese Yemeni or Yemenite Zambian Zimbabwean
Tick if aboriginal or Torres Strait Islander :
Medical Notes :
Password :
Confirm Password :
Password Hint :	Use the Hint to remind you of your password

Address Details:

Street :	*
Suburb :	*
State :	NSW QLD VIC ACT TAS SA NT WA
Postcode :	*

Contact Information:

Home Phone Number :	*
Work Phone Number :
Mobile Number :	Receive Club SMSs?    Yes No
Main Email Address :
Receive Club Emails?	Yes No
2nd Email Address :
Receive Club Emails?	Yes No

Emergency Contact:

First Name :	*
Last Name :	*
Phone Number :
Mobile Number :

Club Information:

Help Committee?	No Player will help Dad will help Mum will help
Be A Manager?	No Player will be Dad will be Mum will be
Be A Coach?	No Player will be Dad will be Mum will be
Be A Referee?	No Player will be Dad will be Mum will be
Preferred Playing Positions :	Goal Keeper : Defense : Midfield : Forward :

Previous Club: (Required if Player is Transferring from another Club)

Previous National Assn :	(If not in Australia)
Previous Association :	(If within Australia)
Previous Club :
Previous Reg No :	(If within Australia)

Suspensions:

Are you currently Suspended?	No Yes
Length of Suspension:	Matches Weeks
Issuing Organisation:

Parents Details: (Required if Player is Under 18 Years)

Parents Title :	Mr Mrs Miss Ms Dr Prof
Parents Name :
Male / Female :	Male Female
Parents Occupation :
Home Phone Number :
Work Phone Number :
Mobile Phone Number :	Receive Club SMSs?    Yes No
Main Email Address :
Receive Club Emails?	Yes No
2nd Email Address :
Receive Club Emails?	Yes No
Parents Title :	Mr Mrs Miss Ms Dr Prof
Parents Name :
Male / Female :	Male Female
Parents Occupation :
Home Phone Number :
Work Phone Number :
Mobile Number :	Receive Club SMSs?    Yes No
Main Email Address :
Receive Club Emails?	Yes No
2nd Email Address :
Receive Club Emails?	Yes No

School Details: (If Under 18 and attending school)

School This Year :	Abbotsleigh Aberfeldy Arden Artarmon Primary Asquith Boys Barker College Barra Brui Pre-School Beaumont Road Belrose Primary Boronia Park Brigidine Burwood Girls High Bush Canberra Chatswood High Corpus Christi Covenant Christian Davidson High Forest Killarney Forest Lodge Primary Garrick Avenue Glenaeon Gordon East Primary Gordon West Highfields International School James Ruse John Colet Kamaroi Killara Killara High Killarney Heights High Kindergarten Kings Kissing Point Knox Kuringai High Ku-Ring-Gai High Lane Cove Lindfield Lindfield East Loretto Marist Brothers Masada McDonald College Mona Vale Primary Montessori Mosman Prep Mt. St. Bernard Narrabeen Sports Newington Normanhurst Normanhurst High North Sydney Boys North Turramurra Northern Beaches Christian Northern Beaches High Northside Montessori Overseas Oxford Falls Grammar Pacific Hill Christian Pittwater House PLC Preschool Prouille Pymble Pymble High Ravenswood Redlands Riverview Ryde German School Sacred Heart Scotts College Shore St Aloysius St Andrews St Andrews Cathedral St Ignatius Riverview St Ives High St Ives North St Ives Park St Ives Primary St Pius St. Leo's College Stanmore Public Sydney Grammar Terrey Hills Christian Terrey Hills Public Turramurra High Turramurra North Turramurra Primary Unknown Wahroonga Wahroonga Primary Waitara Warrawee West Pymble Wideview Willoughby Please specify the school you currently go to
School Year :	Please tell us the School Year you are in now
School Team?	Tick if you currently Play in the School Team

Additional Information:

Non Disclosure :	No Yes YES if the Player does NOT want details disclosed to others in the Club Click for Explanation
Receive KDSA Emails :	Yes No No if the Player does NOT want to receive emails from KDSA
Special Offers :	Yes No No if the Player does NOT want to receive Special Offers from Football Administrators partners
Players Comments :

 

Football Federation Australia Terms :

Please confirm you have read and accept the Football Federation Australia Terms

“The Club and the Player as listed above apply to Football Federation Australia Limited to register the Player with that Club as a AMATEUR PLAYER. By submitting this Form, the Player (or if the Player is under 18 years of age at the time of submitting this Form, that Player’s parent or legal guardian) agree to comply with the Terms (as specified at http://www.footballaustralia.com.au/regulations/terms_NRR03 ) and its incorporated documents, including the FFA Statutes and Spectator Code of Behaviour”

Club Rules :

Please confirm you have read and accept the Club Rules