2023 HORNETS WARATAH SENIOR LEAGUE REPRESENTATIVE PLAYER

All information provided in this document will be copied & kept by the Team Manager and Representative Manager. All information remains confidential.

1PLAYER INFORMATION > 2MEDICAL INFORMATION > 3BASKETBALL DETAILS > 4AGREEMENT
TEAM SELECTION
Type of Player
Please select Representative Team you have been selected within in 2023.
PLAYER DETAILS
Player's Name Player's Name First Last
Player's Date of Birth Player's Date of Birth / DD / MM YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone
Mobile Phone:
Email
Parent (Guardian) Contact Details
ONLY TO BE COMPLETED IF PLAYER UNDER 18

Please provide contact details for player's mother.
Parent/Guardian Email address in which all communication will be sent:
1. Parent/Guardian Name: 1. Parent/Guardian Name: First Last
1. Parent/Guardian Mobile Mobile Phone
2. Parent/Guardian Name: 2. Parent/Guardian Name: First Last
2. Parent/Guardian Mobile Mobile Phone
Please provide any information regarding home life that the Coach or Manager should be aware of.
EMERGENCY CONTACT:

(Other than parent).
Emergency Contact Name: Emergency Contact Name: First Last
Emergency Contact Mobile Phone: