2017 DIOCESAN SECONDARY FOOTBALL (SOCCER) - OPEN BOYS & OPEN GIRLS
CONSENT/MEDICAL/CONTACT/PLAYER PROFILE/INFORMATION FORM
This compulsory registration process is only for those players who would like to be considered to attend the above trials at Woodlawn College, Lismore on 21st March 2017 (back up date 28th March 2017).

Please complete the following form if you would like your child to be considered for selection to attend the above trials. The player profile section of this form will be used mainly to enable convener and selectors to place each participant so that they can best showcase their skills. Please complete by Thursday 16th February 2017, print a copy if you wish, then press SUBMIT (found at the bottom of this form).

Please complete all questions (type N/A where not applicable)

Players First Name *
Your answer
Players Surname *
Your answer
Gender *
Date of Birth *
Date of birth expressed as dd/mm/yyyy (not 2016)
MM
/
DD
/
YYYY
Players Age in 2017 *
Your answer
Sport *
Click on Football (Soccer) below
Required
School *
Schools are arranged in alphabetical order according to town.
Medicare Number *
Your answer
Health Fund Name *
Your answer
Health Fund Number *
Your answer
Medical Information *
Please note here any medical/health information of which managers should be made aware e.g. allergies, dietary restrictions, medication, puffer, epipen, etc . Please type N/A if none.
Your answer
Parent Surname *
Your answer
Parent First Name *
Your answer
Parent Home Phone *
Your answer
Parent Mobile *
Your answer
Parent Email
Your answer
School Representative History *
Must be accurate but don't disadvantage your child by leaving out information you believe selectors should consider. Please indicate if actually selected in a team not just that you attended the trial. Please use point form (NOT sentences).
Your answer
Club Representative History *
Must be accurate but don't disadvantage your child by leaving out information you believe selectors should consider. Please indicate if actually selected in a team not just that you attended the trial. Please use point form (NOT sentences).
Your answer
Preferred Playing Position 1 *
Your answer
Preferred Playing Position 2 *
Your answer
Preferred Playing Position 3 *
Your answer
Codes of Conduct *
Click Yes if player and parents have read and will abide by their respective codes of conduct at these trials and that you understand and accept that your child is to behave in an appropriate manner and have explained this obligation to him/her. Clicking Yes also indicates that you are aware that if your son/daughter seriously contravenes behavioural expectations, he/she may be immediately excluded from the trial. Should this eventuate, you accept full responsibility for your son/daughter upon notification of his/her exclusion by the convener. Yes also indicates that you are aware that the child’s school may take disciplinary action after this event and that future Diocesan sports representation may be in jeopardy.
Consent *
I hereby consent to my son/daughter participating in Diocesan Football (Soccer) Open Trials. I understand that transport to and from the venue and accommodation is a parent/guardian responsibility. In the event of accident or illness I authorise the obtaining on my behalf of any such medical assistance that may benefit my child. I accept responsibility and expenses incurred. Please note that your child's school and/or zone might also require written consent for this activity.
Submit
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