Personal Information
First Name *
Last Name *
Gender * MaleFemale
Email *
Date of Birth *
Phone Number *
Jamatkhana Centre * Perth (WA), Australia
Emergency Contact
Contact Relationship
Add Another Contact Person Remove
Sports Information
Select Sport —Please choose an option—CricketNetball
Select Sport —Please choose an option—Netball
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 Cricket team? What is the name of your Cricket team?
Which of the following cricket skills do you possess? BowlerBatsmanAll RounderWicket Keeper How many seasons have you played?
Which netball positions have you played? Goal ShooterGoal AttackWing AttackCenterWing DefenseGoal DefenseGoal Keeper How many seasons have you played?
For youth (10-17), Game On will create teams to ensure a fair and equitable distribution of the kids across the various date ranges
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
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 by 12 October 2024. The registration fees are as follows: Adult Athletes Fees (18+) $25 per person Junior Athlete Fees (>10 but <18) $15 per person
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