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Details

Under 12 SSA Player Nominations 2024

Tue 23 Jan 2024 09:00 — Mon 20 May 2024 16:00

Tasmanian Hockey Centre

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Date of Birth*

Parent/guardian name*

Parent/guardian email*

I have read and understand the Social Media Policy*

Yes

I have read and understand the relevant information sheet linked on the first page.*

Yes

I have read and understand the state team code of conduct policy*

Yes

I have read and agree to the conditions of acceptance for the Tasmania State Team*

Yes

Which team do you wish to nominate for?*

Which Club do you currently play for?*

Do you have a current pre-existing injury or illness?*

Yes

If yes, please provide brief details of the injury and what treatment you are receiving Max. 255 characters

Do you have a current state playing number?

Please indicate your highest level of playing experience last year*

Please indicate your preferred playing position.*

Is there any additional information that we should be aware of? Max. 255 characters

Please note

All prices are inclusive of GST.
A Nomination fee of $30.00 applies for this event.

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*

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