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Square Membership form
This is used to gather member information for import into Square
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* Indicates required question
First Name
*
This is the member's name (not the parent...please put then parent's name in as emergency contact)
Your answer
Last Name
*
Your answer
Company
You can leave this blank
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Street Address 1
*
Please put in your physical street details (e.g., 4 Mandurah Road)
Your answer
Street Address 2
Your answer
City
*
Your answer
State
*
Your answer
Post Code
*
Your answer
Reference ID
Leave blank for new registrations
Your answer
Email Subscription
If you wish to receive emails about our programs, please select 'subscribed' otherwise ''unsubscribed'.
Choose
Subscribed
Unsubscribed
Unknown
Volunteer Status
Choose
Yes please!
No at this time thanks
Gender
*
Choose
Male
Female
Other
Emergency Contact Number
*
This is the number of the parent or guardian in case of a junior
Your answer
Emergency Contact Name
*
This is the name of the parent or guardian in case of a junior
Your answer
Parental Photo Permission
*
This is for when photos may be taken during general game play
Choose
Yes
No
Date of Birth
*
This is the birthdate for the member (not the parent in case of a junior)
MM
/
DD
/
YYYY
Applying for Kidsport?
*
If you are applying for a Kidsports voucher, please select yes, otherwise no.
Yes
No
If you know it, please put your Voucher Code here—
If you do not have it yet, please email to
admin@mandurahvolleyball.com
when you receive it.
Your answer
Preferred Session Time
This is for our junior programs—
Kids volley is Thursday 4:45–5:45 pm
Teens is Wednesday from 4–6 pm or Thursday 3:45–4:45
Choose
3:45–4:45
4:45–5:45
4:00–6:00
School
*
This is the school the junior member attends
Your answer
Junior Program Payment (
please leave any comments or questions below
)
Volley4Kids
Volley4Teens
You will also need to register for this membership, once per year.
Memberships last from April 1st to March 31st.
Membership with Volleyball WA
Note that these will take you to another page...when you are finished, come back to this one and submit ☺
Your answer
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