2018 DIOCESAN SECONDARY FOOTBALL (SOCCER) - OPEN BOYS & OPEN GIRLS
This compulsory registration process is only for those players who would like to be considered to attend the above trials at Southern Cross Football Centre (Crawford Rd, East Lismore) on 21 March 2018.

Please complete the following form if you would like your child to be considered for selection to attend these 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.

Students/parents should bring a $5 levy 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
Gender *
Date of Birth *
Please ensure you include 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
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 Representative History *
Must be accurate but don't disadvantage your child by leaving our 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 our 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
Commitment *
Please click Yes to indicate that your child is available and committed if selected at Lismore to attend NSWCCC Football (Soccer) selections on 5 & 6 June 2018 at Valentine Park, Glenwood. 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 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 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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