APPLICATION FOR SENIOR PLAYER PATHWAYS
SENIOR REPRESENTATIVE APPLICATION FORM
YEAR: ____________
Given Name
Address
Date of Birth
Surname
Post Code
Country of
Birth
Email
Phone
Do you have a disability?
Are you of Aboriginal or Torres Strait Islander descent?
Are there any languages other than English spoken at home?
Next of Kin (name)
Division/s applicant
wishing to apply for
(select all that apply)
Yes
Yes
Yes
No
No
No
Contact Number
Waratah Cup
ONLY
Div. 5 - 6
Playing Positions(please nominate one position in
Waratah Cup –
Div. 2
Div. 7 - 8
1st preference
Div. 3 – 4
2nd preference
each preference only)
Brief History of Domestic / Representative Play for the last three (3) years
DECLARATION
I hereby accept full responsibility for any injury or accident sustained by the above applicant at all
times. I understand that the Associations and its officials, whilst taking all reasonable care will not be
liable for any claims for compensation under any circumstances.
I confirm I will notify St. George District Netball Association in writing if I accept a position with
another Association or do not accept a position offered to St. George District Netball Association.
Signature of Applicant
Date
(if player is over 18 years of age)
Signature of Parent / Guardian
Date
(if player is under 18 years of age)
Please return completed form to haymakers53@bigpond.com