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Junior Football Squads
Junior Football Registration Form for 2021 Season
Player Name
*
First
Last
Date of Birth
*
Email (for all correspondence to be sent to)
*
Home Address
Mobile
*
School
Year level in 2021
*
Grade 5
Grade 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Finished school
Age group
U/13
U/15
U/17
U/19
Competition played 2019 & 2020
Medical Information
Next of Kin / Emergency Contact
First
Last
Contact Number
Relationship
Doctor's Name & Clinic
Doctor's Phone Number
Medicare Number
Private Health Insurance
Yes
No
If Yes, fund name & member number:
Ambulance Cover:
Yes
No
If Yes, member number:
Dietary requirements / allergies
Please allow us to plan for pie nights, club BBQs & Thursday night teas.
Medical Conditions/ Current Injuries
Please tick if you suffer from any of the following:
Fits of Any Type
Heart Conditions
Asthma
Migraines
Diabetes
Blackouts
Allergies to any tapes
Allergies to any medication
Allergies to other
If Yes to any of the above, please indicate treatment if necessary or elaborate:
I allow photos taken to be used for media purposes:
*
Agree
Do Not Agree
Guardian Consent
Parent / Guardian if player is under 18 years of age
*
Date
Under 13 Squad
Under 15 Squad
Under 17 Squad
About
Life Members
Football
Football Fixture
Football Playing List
Senior Football Results
Senior Football Ladder
Reserves Football Results
Reserves Football Ladder
Under 19s Colts
Junior Football
Netball
2019 Netball Trial Registration
Netball Results
A and B Grade Squad
C and D Grade Squad
Under 19s
Junior Playing List
Sponsors
Social Calendar
Room Hire
Gallery
Shop
Contact