2022 Basketball Program Application Form

Basketball Application Form

Fantastic opportunity to be coached by 2 former Australian Basketball players and coaches - Phil Smyth & Brian Kerle. 2-day clinic for 12-16 Years | Thursday 30th June- Friday 1st July | 9-3pm.
Athlete Information
Athlete's Name

First Name Last Name
Birth Date

Month Day Year
Athlete Email
example@example.com
Parent Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Player Profile
Club Name
Coach
Age Group
e.g. U14
Number of years playing
Evidence of player achievements and experience: e.g. Team selections, Competition involvement/experiences, Coach reference
Option to attach player portfolio can be found at the end of the form.
Parent/Guardian Information
Name

First Name Last Name
Mobile Number
Relationship
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number
Medical Information
Does the athlete have any current or recurring injuries, allergies, chronic illness, or medical conditions? If yes, please describe.
Media Consent
I First Name Last Name herby consent for my son/daughterFirst Name Last Name
photographs and/or videos taken (which may contain their image) during the basketball clinic to be used in any of the Gold Coast Academy of Sports publications and materials (including written, electronic or multimedia materials).
Uniform Size

Please select the most appropriate size as per the measurements provided below for the T-shirt. Once accepted into the program the uniform size will be confirmed and locked in. No refund or exchange will be provided if an incorrect uniform size is selected. All sizes are measured in cm and are to be measured across the chest from under the armpit.

If you require a smaller or bigger size than any of the below, please email the programs manager. programs@goldsport.com.au
T-shirt Size
Thank you for applying for the 2022 2-Day Basketball Academy Program!
Please head to our website for additional program information and schedule.

For further information please contact Annaleise Stoyko, Programs Manager:
0412 756 524 or programs@goldsport.com.au
File Upload

Cancel of
Should be Empty:

Basketball Application Form