SFA-P01 FORM

PERSATUAN FLOORBALL
NEGERI SELANGOR
(No. Ruj. 7052/2014)

Ref. no:
Register Status

PLAYER REGISTRATION FORM

Current club name:

SFA-P01

New

Year:
Late 1

On time

Late 2

Player license no (to be filled by SFA):

PLAYER INFORMATION

Full name:

NRIC or passport no:

Marital status:

First time register with SFA?

Height (cm) :

Playing position : ( F / C / D / GK )

( YES / NO )

Weight (Kg) :

Hand grip : ( LEFT / RIGHT )

Birth date:
(DD/MM/YY)

Age:

Sex:
( MALE / FEMALE)

Address:
Nationality:

Mobile phone no.:

E-mail address :

Occupation:

Employer / Institution / School:

Employer / Institution/ School phone no.:

PLAYERS DECLARATION
I, (full name)

, (NRIC or Passport no)

Hereby declare that:

All information provided in form SFA-P01 is true and complete to the best of my knowledge ad belief.
I undertake that, if admitted as a registered player of Selangor Floorball Association (SFA), I shall be attached to the
registered club as stated above and shall be bound by the SFA constitution, bylaws and policy rules made there under.
I undertake that, SFA, the committee members and relevant associate party of SFA will not be hold responsible for any
unforeseen incidents or mishaps that may occur to me while participating in any events of SFA or SFA endorsed events.
I understand that I am responsible to take all necessary precautions to ensure my own safety.

(Player signature) :

(Date)

(DD/MM/YY) :

PARENTS / GUARDIANS CONSENT (FOR PLAYER BELOW 18 YEARS OLD AT THE TIME OF REGISTRATION)
I, (full name)

, (NRIC or Passport no)

Hereby declare that:

All information provided in form SFA-P01 is true and complete to the best of my knowledge ad belief.
I undertake that, if my child/ ward as named above is admitted as a registered player of SFA, he/ she shall be attached
to the registered club as stated above and shall be bound by the Selangor Floorball Association (SFA) constitution,
bylaws and policy rules made there under.
I undertake that, SFA, the committee members and relevant associate party of SFA will not be hold responsible for any
unforeseen incidents or mishaps that may occur to my child/ ward while participating in any events of SFA or SFA
endorsed events.
I understand that my child/ ward is responsible to take all necessary precautions to ensure his/ her own safety.

(Parent/ Guardian signature) :

(Date)

(DD/MM/YY) :

For SFA use only

Register Status Checklist

FEE

RM

Within transfer window

PENALTY

RM

Transfer window

GRAND TOTAL

RM

New player

RECEIPT NO

Early registration 0

RM 30

New registration 00

RM 30

[Y/N]

Late registration 1

RM 40

Returning player

[Y/N]

Late registration 2

RM 45

DATE

Recurring player

[Y/N]

SIGNATURE

Import player

[Y/N]

[PRESIDENT]

SIGNATURE

[Y/N]
[ 0 / 00 / 1 / 2 ]

Last Register Year

[HON. SECRETARY]

Address: No. 24, Jalan 10/3, Taman Putra, 68000 Ampang, Selangor Darul Ehsan

Approve / Reject

Date:

Reason of rejection :

Contact: +6 017 237 3940

Email: selangorfloorball@yahoo.com