Personal Information
First Name *
Last Name *
Gender * MaleFemale
Email *
Date of Birth *
Phone Number *
Jamatkhana Centre * Brisbane (QLD), Australia
Emergency Contact
Contact Relationship
Add Another Contact Person Remove
Sports Information
Select Sport —Please choose an option—Cricket
Select Sport —Please choose an option—Throwball
Select Sport —Please choose an option—Soccer
Are you interested in leading your team?
For youth (12-17), Game On will create teams to ensure a fair and equitable distribution of the kids across the various date ranges
Coaching
Are you interested in Coaching or Managing a Junior Team at the Local Games? YesNo
Select the sport you are interested in Coaching or Managing —Please choose an option—CricketThrowball
Health Information
Do you have Health Insurance? * YesNoPrefer not to say
Please provide name of your Health Insurer *
Health Insurance Number *
Do you have any allergies? * YesNo
Please provide more details *
Do you have any dietary requirements? * YesNo
Do you have any existing medical conditions? * YesNo
Payment Received YesNo Payment Amount National Payment Received YesNo
Consent
18-Registration-Forms-Consent I accept the terms and conditions
U18-Consent Under 18 Participant - I accept the terms and conditions.
Summary
Please check the information below. If everything looks correct, press submit.
Payment
I understand that this registration will only be confirmed once payment is made at the Jamat Khana. The registration fees are as follows: Adult Athletes Fees (18+) $30 per person Junior Athlete Fees (>12 but <18) $15 per person
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