Personal Information
First Name *
Last Name *
Gender * MaleFemale
Email *
Date of Birth *
Phone Number *
Jamatkhana Centre (Most Commonly attended) * —Please choose an option—VermontNarre Warren
Emergency Contact
Contact Relationship
Add Another Contact Person Remove
Sports Information
Select Indoor Sport —Please choose an option—SoccerNetball
Select Subcategory WomensMixed
Select Subcategory MensMixed
Who is the captain of your Netball team? What is the name of your Netball team?
Who is the captain of your Soccer team? What is the name of your Soccer team?
Which soccer positions have you played? Goal KeeperForwardMid-FielderDefenderNo preference/have not played before What level do you consider yourself? Never PlayedBeginnerIntermediateAdvanced
Which netball positions have you played? Goal ShooterGoal AttackWing AttackCenterWing DefenseGoal DefenseGoal KeeperNo preference/have not played before What level do you consider yourself? Never PlayedBeginnerIntermediateAdvanced
For youth (10-15), 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—SoccerNetball
Health Information
Do you have Health Insurance/Medicare? * 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 16 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 Narre Warren or Vermont Jamat khana by Sunday, 15 September 2024. The registration fees are as follows: Adult Athletes Fees (16+) $30 per person Junior Athlete Fees (>10 but <16) $15 per person
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