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Details

State Championships Exemption Form u14s

8th and 9th June

Northern Hockey Centre, 240 St Leonards Rd, St Leonards

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Are you attending this event?

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Which team do you wish to nominate for?*

u14 Boys

u14 Girls

Which region are you nominating for?*

What selection are you unable to attend?*

Regional trial

State Championships

Parent/guardian name*

Parent/guardian mobile*

Parent/guardian email*

Reason for Exemption* Max. 255 characters

If your reason is due to injury/medical, please upload a medical certificate

Choose file...

Max 5MB

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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