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Latest news
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Netball
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Senior Netball
Our club
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Our life members
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Saints shop
Contact Us
Senior Netball
Please submit your form by
Wednesday, December 9th, 2020.
Thanks for your interest.
Senior Netball Expressions of Interest 2021
Player details
Name
*
Player name
First
Last
Player date of birth
*
Date Format: DD slash MM slash YYYY
Email (for correspondence to be sent to)
*
Home address
Street Address
Address Line 2
City
State
Post Code
Mobile phone
*
First preferred position
*
GS
GA
WA
C
WD
GD
GK
Second preferred position
*
GS
GA
WA
C
WD
GD
GK
Do you have any planned holidays or trips during the season? If so, please provide dates and details.
Current club/association
Emergency Contact Details
Name
*
Emergency contact name
First
Last
Phone number
*
Emergency contact phone number
Relationship to player
*
Medical information
Doctor's name & clinic
*
Doctor's phone number
*
Medicare Number
*
Private Health Insurance
*
Yes
No
Fund name and member number
*
Ambulance cover
*
Yes
No
Please tick if you suffer from any of the following:
Fits of any type
Heart condition
Asthma
Migraines
Diabetes
Blackouts
Allergies to any tapes
Allergies to any medication
Allergy to other
Medical information
If yes to any of the above, please indicate treatment if necessary or elaborate.
Player consent
CONSENT: I understand that netball is a limited contact sport and that there is a risk of injury involved in playing netball. I authorise any official from Birregurra Football Netball Club in charge of selections, in the event of any injury or illness, to obtain on my behalf and at my expense any medical assistance, treatment and transportation as deemed necessary. INDEMNITY: Except where provided or required by law and such cannot be excluded, I agree that Birregurra Football Netball Club and its respective committee members and coaches are absolved from all liability, however arising from injury or damage to me, however caused, arising whilst participating in the selection trials. I have read, understood and agree to the above terms. I warrant that all information provided is true and correct.
I allow photos taken of me to be used for media purposes
*
Yes
No
Accept terms and conditions
*
By ticking this box, you are indicating you have accepted the terms and conditions outlined above.
I accept terms & conditions
Name
This field is for validation purposes and should be left unchanged.