Tooradin Netball 2018

1
Age groupAge of player as at 31st December in the playing year
Senior
17 & under
15 & under
13 & under
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2
Name
First Name
Last Name
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3
Email NOTE: All correspondence from Tooradin-Dalmore NC will be via Email
example@example.com
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4
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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5
Phone Number
Area Code
Phone Number
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6
D.O.B
Date
Year
Month
Day
Date
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7
Person responsible for payment of fees
Player
Parent/Guardian
Player sponsor
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8
Nameplease skip if payments are from Player or Sponsor
First Name
Last Name
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9
Phone Numberplease skip if payments are from Player or Sponsor
Area Code
Phone Number
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10
Emailplease skip if payments are from Player or Sponsor
example@example.com
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11
Where did you play last seasonWhat level/grade?
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12
Position preference 1st - 2nd - 3rd
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13
Netball Vic number (VNA) If NOT PAID for current year, Netball Vic. Registration must be paid online prior to taking part in any training and/or matches. Further details will be provided about this during pre-season.
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14
1st Emergency Contact Name
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15
Relationship to Player
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16
Phone Number
Area Code
Phone Number
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17
2nd Emergency contactName
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18
Relationship to Player
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19
Phone Number
Area Code
Phone Number
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20
Does the player have any relevant Medical Conditions? i.e. asthma, diabetes, epilepsy, migraines, heart conditions. If yes, please list details;
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21
Does the player have any Allergies? please include allergies to drugs, medications, foods or other e.g. bee sting. If yes, please list details;
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22
Does the player have any Injuries? both recent and pre-existing. If yes, please list details
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23
Does the player have any other relevant Medical History not listed above? both recent and pre-existing. If yes, please list details;
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24
Does the player have Ambulance cover?
Yes
No
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25
In the event of an accident whereby immediate attention is required, I hereby give Tooradin Dalmore Netball Club Officials permission to contact an ambulance, doctor, or hospital if I am incapacitated or the parent/guardian cannot be contacted
I Agree
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26
I/my child agree to notify Team Officials if any of the above Medical Details change before taking part in training or matches.
I Agree
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27
I agree that my/my child's fees will be paid in full, or arrangements made with the Treasurer before the 1st round of the season and I am aware that if I fail to do so I will not be able to participate in matches until payment is made.
I Agree
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28
I agree that images and/or names of Tooradin-Dalmore Netball Club members, including myself/my child may be used for promotional purposes in any media including WebPages and social media such as Facebook.
I Agree
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Should be Empty: