Sydney South Hockey Association REPRESENTATIVE PLAYER NOMINATION FORM
Please fill out all questions
Personal Details- Please Print
Player Surname *
Your answer
Player Given Name *
Your answer
Address *
Your answer
Suburb *
Your answer
Postcode *
Your answer
Players Date of Birth *
Your answer
Players Club *
Your answer
Players email *
Your answer
Primary Email contact if different to players email *
Your answer
Players primary contact mobile N#
Your answer
Parent/ Guardian Names: *
Your answer
Parent/ Guardian Mobile Phone Numbers *
Your answer
Playing specifics
Preferred Playing position 1 *
Goal Keeper, Defence (Centre, Right, Left), Midfield (Attacking, Defensive), Striker (Centre, Right, Left)
Your answer
Preferred playing positions 2 *
Goal Keeper, Defence (Centre, Right, Left), Midfield (Attacking, Defensive), Striker (Centre, Right, Left)
Your answer
Preferred Playing Position 3
Goal Keeper, Defence (Centre, Right, Left), Midfield (Attacking, Defensive), Striker (Centre, Right, Left)
Your answer
Team you are nominating for *
Note: If you wish to nominate for the age above your current age please indicate by ticking the box. Example if you have a 2001 Birthday you are in U15's (in 2016) however you would also like to nominate for U18's, please tick two boxes.
Required
Are there any health issues that you are currently suffering that would prevent you from participating or potentially affect your participation (e.g. asthma) in the selection process for an SSHA team? *
If Yes please provide details
Your answer
Players History
e.g State Championships attended, club level
Your answer
Statement of Committment
I understand that to be selected in a Sydney South Hockey Association representative team I need to attend trials and participate in the trial process. Trials will be conducted according to the Sydney South Hockey Association Representative Selection Policy.
(A sign off document will need to be signed at the first session)
The approximate cost for a player in the representative program will cover the following items (below) and ranges from $130-$180 for program, optional skill development program $80-$140, uniform fee $30-$130 and $300-$500 for State championships Accommodation and Travel, depending on where the State Championships is held. Do you understand that these payments will be required at least 2 months after team announcement.
Program cost includes turf hire, carnival entries, trial matches and umpire fees, presentation day. The State fee will be for state entry, umpire fees,turf hire, coach/ manager allowance, accommodation and travel. Skill development program will run during the season for players who looking for extra skill work.
The SSHA rep program will involve 6-10 training sessions, 3-4 trial matches, 3-5 weekend carnivals and two 3 day carnivals one of which will be a state championships. This will be your time commitment over the next 3-6 months.
Understanding the level of commitment is important
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