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De Beers AFC Junior Registration Form P.O. Box 2658, Somerset West, 7130 WWW.debeersafc.co.za Club Email: [email protected] Tel: 083 780 4674 Laurel Gentry Email: [email protected] Surname: New Member First Name: Existing Member Identity Number: Date of Birth: Home Address: Cell No: Work/Home: Father Name: Cell No: Mother Name: Cell No: E-mail Address School: Grade: Medical Aid: Medical Aid No: NB: ALL MEMBERS: De Beers AFC Reg form, School Verification, CTTFA & SAFA forms, 2 x Colour ID Photographs and a copy of ID Document / Birth Certificate (If you are an existing member check with Laurel what is required for registration for current year). ADMINISTRATION FEE : R250.00 A non refundable administration fee is due on submission of registration document. SUBS 2014 SEASON : U7 – U17 , Colts & Ladies --- R600.00 Second & subsequent child --- R250.00 U5 only the Administration Fee TRANSFERS: All transfers will cost R100.00. A duly authorized clearance certificate is required if the player last played for another club prior to seeking registration with De Beers AFC. Accepted methods of payment: Cash , Cheque & EFT’s . Subs are payable in full or in 3 monthly installments, and full subs are due by end of May 2014. Players’ card will only be issued once R 500.00 subs paid. If full subs not paid by end of May 2014 the players’ card will be withdrawn, no activity (training or matches) will be allowed until full payment is received. No Refunds will be entertained. Banking details : De Beers AFC, Standard Bank, Branch Code 033012, Current Acc No. 072 296 852, Ref: Players Name/Sub’s 2014 – Copy to accompany registration forms. INDEMNITY : The member/guardian hereby give consent to take part in football and related activities at De Beers AFC grounds and at applicable venues for away matches. The member / guardian acknowledge that transportation is their own responsibility and not that of De Beers AFC – this covers all transportation to and from my residence, De Beers AFC and away matches. The consent given shall include transportation of the child member / adult member by other persons to applicable venues. This shall be undertaken at the member/guardian’s own risk, and I, my spouse, and our executors on behalf of my aforesaid child member / adult member, hold harmless and absolve De Beers AFC, the Chairman, other members, Managers and relevant drives against any and / or all claims of whatsoever nature that may arise in connection with loss or damage to property, or injury to the child member / adult member, or death of the aforesaid. De Beers AFC, the Chairman, Managers and drivers will nevertheless take all reasonable precautions for the safety and welfare of the child member / adult member as far as is possible. I, the undersigned, in my capacity as player, member or parent, understand and agree to abide by the De Beers AFC Code Of Conduct and the Club Constitution. I agree to abide by any ruling handed down by the Club’s Disciplinary Committee relating to any misconduct by myself or my child/ren. Date: __________ Name: ____________________________ Signature: _____________________________________________ Parent/Guardian if Under 18 years Please indicate how you can support De Beers AFC i.e. field upkeep / building / materials / donations / sponsorship / transport etc:
