Small Ball Registration Form
Small Ball is a program tailored for our youngest of players (5 & under). It is about having FUN all the while
providing motor-skill development, spatial awareness and social learning. It is NOT competitive games, simply
an hour of FUN!
Where: Cotton On Foundation Ipswich Basketball Stadium
2a Ross Llewellyn Dr, Booval, 4304
When: Every Saturday (except School Holidays)
Starting 9th February 2013
11:30am-12:30pm
Cost: $5/session
Registration Method
Fax No:/email address
Send to: 3282 4905 / marney.george@basketballqld.net.au
Payment is to be made to the coach on the day.
_____________________________________________________________________________
Name:___________________
DOB: _________
Address:
Email Address: ____________________________________________________________
Medical Conditions: ________________________Where did you hear about Small Ball?___________
Gender:
Male / Female
PARENT/GUARDIAN (Print Name): _______________________________________________
Contact Numbers: _________________________
Mob:_______________________
SIGNATURE: _________________________________________________________________
I hereby authorise the staff and volunteers of Queensland Basketball Inc and Small Ball Officer to act for me according to their best
judgement in any emergency requiring medical attention and I agree to hold Queensland Basketball Inc and its staff and volunteers and
the Small Ball Officer harmless and indemnify them in respect of anything so done. In addition, I hereby waive and release Queensland
Basketball Inc and its staff and volunteers and the Small Ball Officer from any liability for any injury or illness sustained or experienced
whilst at the Small Ball Program, whether arising through the negligence or breach of contract of them or any of them or from any other
cause. I understand that public liability and professional indemnity insurance is held by Queensland Basketball Inc, but subject to the
terms of the relevant policies, and that personal injury insurance is held for financial participants appropriately registered with
Queensland Basketball Inc through a member Association of Queensland Basketball Inc and for participants in the Small Ball program but
only for the duration of the program, for the purpose of playing basketball and actively engaged in that sport. I also understand and
agree that Queensland Basketball Inc has the right to use for publicity and advertising purposes photographs of players and participants
taken at the clinic.