WRAS 2018 netball squad - phase 1 trial

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Sunday 27 August 2017 (Orange) OR Sunday 3 September 2017 (Dubbo).

Player nomination

Please select your 1st preference for date and location *

Sunday 27 August 2017 - Orange

Sunday 3 September 2017 - Dubbo

First name *

Surname *

Date of birth *

Email *

ALL future correspondence will be sent to the email address you provide

Town you live in *

Netball association you are registered with *

Your Netball NSW registration number *

Your height in cm *

What is your major netball achievement to date *

Playing position - 1st choice *

Centre

Goal Attack

Goal Defence

Goal Keeper

Goal Shooter

Wing Attack

Wing Defence

Playing position - 2nd choice *

Centre

Goal Attack

Goal Defence

Goal Keeper

Goal Shooter

Wing Attack

Wing Defence

Do you have any medical conditions that WRAS should be aware of? *

Yes

If yes please provide details

Declaration and Authority

I give permission to the Western Region Academy of Sport (WRAS) 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 WRAS. I understand that I will be contacted as soon as possible should medical assistance be needed for my child/ward.

By ticking the box below you are accepting the terms stated in 'Declaration and Authority' above *

I have read and fully understand the above Declaration and Authority

Required

Enrolments close on 10am Thursday 17 August 2017

The WRAS office must receive the nomination form and full payment by the closing date/time. Acceptance of nominations will be acknowledged by email. Please note no confirmations will be emailed before 17 July 2017.

Payment details

Direct Deposit is the preferred method of payment
Reliance Bank
Account Name: WRAS
BSB: 882 000
Account No: 300015812
Please include the name of your child/ward as the payment reference

If you do not use electronic banking please contact the WRAS office phone 6338 4821 or email tpallier@wras@csu.edu.au to discuss payment options to ensure you meet payment deadline.

Cancellation and Refund Policy

Cancellations must be advised in writing (email to tpallier@csu.edu.au).
* Cancellations received by the WRAS office before the closing date of 17 August 2017 will receive a full refund
* Cancellations received on or after the closing date of 17 August 2017 will incur a $20 administration fee

By ticking the box below you are agreeing to the 'Cancellation and Refund Policy' above *

I have read and fully understand the above Cancellation and Refund Policy

Required

Name of parent/guardian *

Phone number of parent/guardian *

For further information

Please contact Tanya Pallier, WRAS Office Manager phone 6338 4821 or email tpallier@csu.edu.au (please note Tanya will be away from the WRAS office between 30 June and 17 July 2017 - enquiries will be answered after 17 July 2017)

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Western Region Academy of Sport. Report Abuse

Forms