BRISBANE NETBALL ASSOCIATION 2015 PREMIER LEAGUE NOMINATION FORM

Transcription

1 BRISBANE NETBALL ASSOCIATION 2015 PREMIER LEAGUE NOMINATION FORM 19 Years 16 Years Closes: Wednesday 28 January 2015 Nomination Fee: $15.00 (to accompany completed nomination form) Nominations are hereby called for players wishing to be considered for selection in Netball Qld s Premier League Competition in 2015 in a Brisbane Netball Association team in Under 19 and Under 16 divisions. All players will need to be available to play fixtures at the State Netball Centre, Klumpp Rd, Mt Gravatt on either a Thursday or Friday evening or Sunday afternoon. Specific times will be advised once this information is received from Netball Qld. Players will also need to be available for training at least once a week. Players ages are taken as at 01/01/15 and are as follows: Under 16 Players born 1999 and 2000 only. Under 19 Players born 1996 or later. Open Players born in any year. Selection trials for 2015 Premier League - Sun 1 Feb pm at Wavell State High School, Childers Street, Wavell Heights. NOMINATION FEE: $15.00 (to accompany completed nomination form) LATE NOMINATION FEE: $20.00 (received after 28/2/15) Nominations close on Wednesday 28 January Late nominations will be accepted however will be required to pay the late nomination fee. COST: PLAYERS EXPENSES: Approximately $ (includes Netball Qld nomination fees, umpiring for Premier League fixtures, coach payments, equipment etc) UNIFORMS Travel to and from games each week at the State Netball Centre. Indoor training court fees (if indoor venue is designated by coach) COMMITMENT:

2 * Make yourself available for the NQ Grading Trial days. These are usually held in Feb/March and will be advised once Netball Queensland provides the dates. All grading matches to be played at the State Netball Centre, Klumpp Rd, Mt. Gravatt. * Make yourself available for at least one training session per week at the coaches discretion. * Provide own transport to and from State Netball Centre each week. * Be available to play in weekly fixtures normally from approximately March through until August/September, or as stipulated by Netball Queensland at the State Netball Centre, Mt Gravatt. Selected players must also be registered and playing in a current Brisbane Netball Association club team in the Winter Day or Night Season.

3 2015 Premier League Nomination Form THIS NOMINATION FORM MUST ACCOMPANY A COMPLETED MEDICAL AND PHOTO PERMISSION FORM. Name: Address: P/Code: Phone Numbers: (H) (M) Address : (please ensure an accurate address is supplied as this is used as the main form of communication between the association and players) Parent/Carer Name/s: Date of Birth: Club: Winter Season Team: Nominated Positions: Players Signature Parent/ Guardian Signature (if under 18) OFFICE USE ONLY: DATE NOM. PAID: MEDICAL FORM RECEIVED:

4 Brisbane Netball Association Medical Form SURNAME: CHRISTIAN NAMES: ADDRESS: POST CODE: DATE OF BIRTH: ADDRESS: PHONE NUMBER (Home): MOBILE NUMBER (Parents): MOBILE NUMBER(Player): SCHOOL ATTENDED: or OCCUPATION: EMERGENCY CONTACT: RELATIONSHIP TO PLAYER: CONTACT NUMBER: MOBILE: MEDICAL PRACTITIONER: - PHONE NUMBER: DO YOU HAVE PRIVATE HEALTH INSURANCE YES/NO (Please circle) IF YES PLEASE STATE NAME OF AGENCY: MEDICARE NUMBER: Do you suffer from any of the following? Please state medication given or treatment used: ASTHMA HEART DISEASE DIABETES EPILEPSY ALLERGIES BLOOD PRESSURE HEPATITIS B/C RHEUMATIC FEVER GLANDULAR FEVER JOINT INJURIES/STRAPPING TRAVEL SICKNESS SLEEP WALKING OTHER ILLNESS/DISABILITY

5 PLEASE LIST MEDICATION PRESCIBED TO YOU BY A MEDICAL PRACTIONER (AND REASONS FOR TAKING SAME) IN CASE OF ACCIDENT: Does the BNA Official have your permission to seek appropriate medical help? YES NO Are you or your child permitted, if necessary, to receive a blood transfusion? YES NO Are you or your child permitted, if necessary, to receive anaesthetic? YES NO Can you or your child take ASPIRIN? YES NO Are you or your child allergic to PENICILLIN? YES NO Are you or your child immunised against TETANUS? YES NO AUTHORITY FOR MEDICAL ATTENTION I (print name), hereby give permission for the officials of Brisbane Netball Association to obtain medical attention for my daughter/myself as required. Player Parent/Guardian Date AUTHORITY TO TRAVEL IN CAR DRIVEN BY BNA OFFICIAL For some events teams travel to/from the event by private transport ie Mini-Bus or Car driven by BNA official. Please fill in the below clause for this purpose. If this is to occur, where possible the parent/carer will be informed beforehand. I (print name), hereby give permission for my daughter to travel in a car/bus driven by a Brisbane Netball Association official as required. Player Parent/Guardian Date

6 Dear Parents, Players and Umpires, Brisbane Netball Association Photo Permission Form From time to time, Brisbane Netball Association uses photos and video footage of our representative teams and individual players for publicity purposes. Photos and video footage are used for internal publication and analysis, display on the website, display at public events and/or for use by the media and affiliate organisations. If photos become available, we would like your permission to use photos of your child or yourself. Please complete the form below and return along with all relevant paperwork. I give permission for photos or video footage of to be used by Brisbane Netball Association for various internal and external publications including for use on the website and social media forums and/or for internal analysis (i.e. providing individual player feedback). SIGNED: DATE NAME: