2018 DIOCESAN SECONDARY RUGBY LEAGUE OPEN AND U15'S TRIALS
This compulsory registration process is only for those players who would like to be considered to attend the above trials at Woodlawn on 21 March 2018. 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.

If your child is selected to attend these trials and is successful in being selected in the Lismore Diocesan Open or U15's team, he will participate at the NSW CCC Northern Country Rugby League Selections to be held at Smithtown on 11 April 2018. For these trials you will be required to organise your own travel and accommodation.

Students/parents are to bring the $5 levy with them on the day and give it to the convener.

Please complete by no later than 23 February 2018.

Please complete all questions or type N/A where not applicable.

Players First Name *
Your answer
Players Surname *
Your answer
Date of Birth *
Please ensure you list your child's year of birth, not "2018"
MM
/
DD
/
YYYY
Players Age in 2018 *
Note: this is the age they will be turning in 2018
Your answer
Sport *
School *
Listed alphabetically by Town/Suburb
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 Representation Rugby League History (Primary School) *
Please tick the CORRECT boxes. You must have actually played for the team you are ticking, not just attended the selection trial for it (we will check).
Required
School Representation Rugby League History
If you selected "Other" above, please give details
Your answer
School Representation Rugby League History (Secondary School) *
Please tick all the CORRECT boxes. You must have actually played for the team you are ticking, not just attended the selection trial for it.
Required
School Representation Rugby League History
If you selected "Other" above, please give details
Your answer
Representation
Group 1
Group 2
Group 3
Group 18
Under 13s
Under 14s
Under 15s
Under 16s
Under 18s
(18s only) Did you represent North Coast Under 18s in 2017?
If you selected "Other" above, please give details
Representation Gold Coast Titans or Newcastle Knights *
Required
Representation Gold Coast Titans or Newcastle Knights
If you selected "Other" above, please give details
Your answer
Any other Representation/Other Comments? *
This section is an opportunity for any player who has moved from another area to the North Coast. Please list below any other rugby league representation. Be brief and 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
Commitment *
Please click Yes to indicate that your child is available and committed if selected at Woodlawn to attend Northern CCC Trials on 11 April 2018 at Smithtown. If no please withdraw from the Diocesan Trial and DO NOT COMPLETE THIS FORM.
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 you have explained this obligation to your child. Clicking Yes also indicates that you are aware that if your child seriously contravenes behavioural expectations, they may be immediately excluded from the trial, Should this eventuate, you accept full responsibility for your child upon notification of their 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 child participating in Diocesan Secondary Rugby League 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 medial 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.
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