Victoria U18 Schoolboys Player Registration & Medical Form

Victoria U18 Schoolboys Player Registration & Medical Form 2023

Fill out the form carefully with details matching passport/birth certificate
Player Name*

First & Middle NameLast Name
Please upload an appropriate selfie photo to aid in selection recognition:*

Browse Files

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Birth Date*

DayMonthYear
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Player Mobile Phone Number*

Area CodePhone Number
Player Email
example@example.com
School*
Position Trialing For - one position only:*

PropHookerLockBack-row (6, 7, 8)Scrum-halfFly-halfCentreWingFull Back
Team kit size selections
Jersey*
Size selection
Shorts*
Size selection
Socks*
Size selection
Jacket*
Size selection
Medical Details
Medicare Number*
Is the player presently taking any medication? Type No if none or list if yes*
All medicines must be handed to the manager in charge prior to leaving for the tour, with the player' s name, the dose to be taken and when it should be taken. (These will be kept in the first aid kit and distributed as required). Please do not allow players to be in possession of any medicine while on the tour.
Does the player suffer from, or require medication to prevent any medical issues? Type No if none or list if yes*
Does the player suffer from any allergies? Type No if none or list if yes and severity (minor - antihistamine, anaphylaxis - epipen etc.)*
Does the player have any particular dietary requirements? Type No if none or list if yes*
What was the date of the player’s last tetanus immunisation?

DayMonthYear
Please note: If almost ten years since last immunisation, a booster shot should be obtained as soon as possible.
How would you rate the player's swimming ability? Is there any reason the player cannot be submerged underwater?*
Unable: Nothing more than dog paddle; Poor: Basic strokes, only limited strokes beyond domestic swimming pool; Good: Strong swimmer able to confidently swim in a variety of water conditions, surf, lakes and rivers; Excellent: Very strong and confident, (could swim 50 metres fully clothed in a variety of water conditions)
Other important information
Guardian Name*

First & Middle NameLast Name
Guardian Mobile Phone Number*

Area CodePhone Number
Guardian Email*
example@example.com
Guardian Confirmation

By checking this box I confirm that I am the guardian of the player listed and that all information is correct
Guardian Digital Signature*

Clear
Should be Empty:

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Victoria U18 Schoolboys Player Registration & Medical Form 2023

Team kit size selections

Medical Details