EmailMe Form - Marie Little Shield Team Player Application

Player Name *

First Last

Player Email *

Player Mobile *

Player Date of Birth *

DD / MM / YYYY

Player Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Positions *

Name of current netball team *

Netball Association

Have you played for Marie Little Shield team previously? *

Yes (see below)

No

If yes, please give details below

Please detail years and teams

Additional playing experience

Emergency Contact Name *

First Last

Emergency Contact Email *

Emergency Phone Number *

COVID-19 Vaccination Satus *

Double vaccinated

Not vaccinated

I do not wish to disclose

Please provide information, if you wish:

Would anyone be travelling to the competition in Sydney? *

Yes, family

Yes, carer

No

Other

Please detail all medical conditions and any medications you take (including supplements)

Please list any pre-existing injuries

Please list any physical disabilities or range of movement inhibitors

Sport Inclusion Australia Form *

Include form and required evidence