ST PAULS UNITING SPORTING CLUB INC.
QUEENSLAND CHRISTIAN SOCCER ASSOCIATION INC
Return to: The Club Registrar, Darryl Miles
481 Broadwater Road, Mansfield,4122
[email protected]
2017 SOCCER PLAYER REGISTRATION FORM
PRIVACY STATEMENT: The QCSA Registration Form requires the provision of personal information eg. name, contact
details and birth date. This information is required for registration & membership purposes with the QCSA Inc. and the
relevant club. Full names may be used on the QCSA website and newsletters where appropriate or necessary, eg. Player of
the Year. QCSA Inc. WILL NOT make any identifying information available to any other parties without consent UNLESS
required in the ordinary operation of the QCSA Inc. eg. compliance with the QCSA Inc. Constitution, Rules and By-Laws,
insurance, or other lawful purposes outlined in Information Privacy Principle #10 (Qld).
PLAYER DETAILS: INFORMATION TO BE PRINTED ( not written )
Surname:
First Name:
Previous QCSA
Club:
Phone:
Ph Mobile:
Saturday Ph no:
Emergency contact
name:
D.O.B.:
Emergency contact
phone no:
Age at 31/12/16:
Male
Female
Address:
Email:
Please note that email is the primary method of communication from the Club & MyClubMate
How did you hear about
St Paul’s Soccer Club?
Family / Friend / Newspaper / Web Site
If other please
advise.
PLAYER / PARENT DECLARATION: (PARENT SIGNATURE REQUIRED IF PLAYER UNDER 18 ).



I hereby apply for registration with the QCSA Inc. as a member of St Pauls Uniting Sporting Club Inc.
I agree to abide by the following to which the QCSA subscribes (these are available at http://www.qcsa.org.au).
1. The Rules & By Laws of the Queensland Christian Soccer Association Inc.
2. The Laws of the Game (LOTG) of Soccer as governed by FIFA; and
3. The Standards outlined in the Active Australia “Codes of Behaviour”.
I am aware that the Association holds an insurance policy to cover me (available at http://www.qcsa.org.au).
(Parents signature
Required if Player is aged
under 18 years)
Player/Parent Signature:

As a Parent / Guardian of the above player I agree to abide by the Parents and Spectators Codes of
Behaviour as outlined by Active Australia.
Parent names:
Skills that could be
volunteered to St Pauls
Uniting Sporting Club Inc:
CLUB USE ONLY:
I hereby certify that I have sighted proof of age of the above player, or that the player has previously been registered as a
member of this club.
Club Official:
2016 team /age group:
2017 Age / Division
(Preferred):