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2017 CRONULLA SHARKS TRIAL APPLICATION FORM
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* Indicates required question
Which team would you like to nominate to trial:
*
Choose
Harold Matthews (U16 years old in 2017)
SG Ball (U18 years old in 2017)
NYC/Holden Cup (U20 years old in 2017)
First Name:
*
Your answer
Last Name:
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Email:
*
Your answer
Player Contact Number:
*
Your answer
Street Address:
*
Your answer
Suburb:
*
Your answer
State:
*
NSW
QLD
VIC
WA
ACT
SA
NT
TAS
Other:
Country:
*
AUSTRALIA
NEW ZEALAND
Other:
PLAYER MANAGER NAME:
Your answer
PLAYER MANAGER CONTACT:
Your answer
ABORIGINAL/TORRES STRAIT ISLANDER DESCENT:
Your answer
2016 JUNIOR LEAGUE CLUB:
*
Your answer
2016 JUNIOR LEAGUE DIVISION:
*
Your answer
REP TEAM HISTORY (Jnr Reps, Development, Academy, school, regional, state, national etc):
*
Your answer
Preferred Playing Position 1
*
Choose
Fullback
Wing
Centre
Halfback/Five Eighth
Hooker
Edge Back Row
Middle - Front Row
Middle - Lock
Preferred Playing Position 2
*
Choose
Fullback
Wing
Centre
Halfback/Five Eighth
Hooker
Edge Back Row
Middle - Front Row
Middle - Lock
Coaching Reference - Name:
*
Your answer
Coaching Reference - Contact:
*
Your answer
If you are from outside of the Sydney Metropolitan area, do you have access to local accommodation (with family and friends etc) if you were successful in gaining a position?
YES
NO
NOT APPLICABLE
Clear selection
If yes, provide details:
Your answer
Highlights Link (web link i.e. YouTube, DropBox etc) - Please limit to 3-4 mins of highlights only. No full games please.
Your answer
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