Register For Junior Cricket - Boys or Girls

Given Name *

Surname *

Male or Female? * MaleFemale

Date of Birth *

Email Address *

Home Address *

Suburb *

Postcode *

Mobile Phone (If applicable)

School *

Year Level *

Parent / Guardian 1: Name *

Parent / Guardian 1: Phone *

Parent / Guardian 2: Name

Parent / Guardian 2: Phone

Are you a returning player? * YesNo

If 1st season with Mt Eliza please list previous club played with?

List any other players you wish to be in a team with.

Emergency Contact Name *

Emergency Contact Number *

List any medical information, injury, illness, allergy or medical condition

Doctor’s Name

Doctor’s Phone

Tick here if you would like to receive information about club sponsorship packages

I agree to the Mt Eliza Cricket Club code of conduct, terms and conditions of registration and privacy policy each which is available on this website. *