Premier Pick-up Registration Form
We are launching Premium Pick-up games in 2023. For players, teams and coaches. Register now >>
Player Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Country Code - Area Code- Phone Number
Date of Birth (DD/MM/YY)
Gender
*
Male
Female
Have you downloaded the Heart & Soul Hoops App?
*
Yes
No
Player Level
*
Please Select
Beginner
Intermediate
Advanced
Uni
Select your preferred playing time(s) in Term 2
Saturday 6-8 pm @ Dural Recreation Centre
Sunday 12-2 pm @ Bernie Mullane
School/Club
Emergency Contact
*
First Name
Last Name
Emergency Contact Number
*
Country Code - Area Code- Phone Number
For COVID-safety, players over 16 years must be vaccinated. Are you vaccinated?
*
Yes
No
How did you hear about us?
*
Please Select
Friend Referred Me
My Basketball Club
My School
Heart & Soul Hoops
International Sports Camps
Redfield Basketball Club
Blue Devils Team
Other
Did a Coach refer you? If yes, please select your Coach's name below:
*
Please Select
Coach Alex
Coach Chris
Coach Ves
Coach Anson
Coach James
Coach Stacy
Any injuries, medical conditions, allergies, etc.
Submit
Should be Empty: