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Representative Representative

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2025 U14 Boys Queensland State Championships

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Details

Sun 06 July 2025 08:00 - Wed 09 July 2025 17:00

Rockhampton Hockey Fields

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Date of Birth*

Preferred playing position

Striker

Midfield

Defence

Goalkeeper

Secondary playing position

Striker

Midfield

Defence

Goalkeeper

Emergency Contact*

Name*

Phone*

Email*

Relationship to nominee*

Any Medical Issues?*

Please select all that apply

Allergies (provide details below)

Asthma

Epilepsy

Other (provide details below)

Other details Max. 255 characters

Event Waiver

By accepting this waiver, you agree to the following conditions. You must:

make yourself available for all selection trials
advise coach/manager if unable to attend trials/trainings
advise coach/manager of any illness/injury concerns

I confirm that I have read the above Event Waiver in its entirety.*

I agree to the Event Waiver.*

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*

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gladstonehockey@gmail.com
0409 574 336

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