WAAC interest form
Name
First Name
Last Name
Email
example@example.com
Mobile number
Date of birth
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you are disabled can you tell us more about this disability - please note - all records on disability are kept for sport qualification purposes only. We need to know how best to support you and your disability.
Please tick one
Disabled athlete
Non disabled athlete
Emergency Contact
Do you have any underlying health conditions (these could be associated with your disability or completely separate) - again we need to know how to best support you
Your preferred position:
Base
Back
Flyer
Front support
If you DO currently train with an allstar / uni team please type this team name here:
Is there anything else you want to tell us?
Submit
Should be Empty: