WRAS AFL trial for 2018 squad
Date - Monday 5 February 2018
Athlete nomination form
Athlete's personal details
First name *
Your answer
Surname *
Your answer
Date of birth *
Your answer
Gender *
Email *
ALL correspondence regarding the trial will be sent to the email address you provide
Your answer
Address *
Your answer
Town *
Your answer
Postcode *
Your answer
Current school year *
Your answer
Current school *
Your answer
Which AFL club do you play with? *
Your answer
Are you of Aboriginal or Torres Strait Islander decent? *
(for statistical purposes could you please answer)
Do you have a disability? *
(for statistical purposes could you please answer)
Medicare number *
Please ensure all 10 digits are included
Your answer
Position on card *
Your answer
Valid to *
Your answer
Do you have any medical conditions that WRAS should know about? *
If yes, please provide details
Your answer
Declaration and authority
I give permission to the staff at the WRAS AFL trial for my child/ward to be treated in the event of illness or accident. I also undertake to pay all costs (eg ambulance travel), medical fees and/or cost of necessary medication which may be incurred whilst my child/ward is in the care of the Western Region Academy of Sport. I understand that I will be contacted as soon as possible should medical assistance be needed for my child.
*
Name of parent/guardian *
Your answer
Phone number of parent/guardian *
Your answer
By submitting this form to WRAS the athlete
makes the following declaration:
I am applying for a position in the WRAS 2018 program. I have read and understand the information sheet and selection criteria for the program. If selected I will fulfil all obligations of the WRAS program.
*
By submitting this form to WRAS the parent/guardian
makes the following declaration:
I have read and understand the information sheet and selection criteria for the WRAS program and give my child/ward permission to apply for a position in the WRAS 2018 program.
*
Enrolments close 5pm on Tuesday 20 February 2018
The WRAS office must receive the enrolment form by the closing date. All enrolments will be notified by email.
For further information please contact Tanya Pallier, WRAS Office Manager by phone 6338 4821 or email tpallier@csu.edu.au
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