Hastings NAIDOC Sports Challenge Registration Form

Hastings NAIDOC Sports Challenge Registration Form

Hosted by Hastings NAIDOC Committee in collaboration with Basketball NSW
Name

First NameLast Name
Date of birth

MonthDayYear
Date
Are you Aboriginal / Torres Strait Islander

AboriginalTorres Strait IslanderAboriginal and Torres Strait IslanderNeither
Gender

MaleFemaleOther
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Postcode

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Relationship to Participant
Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Team Name (if applicable)
Other players on your team (if applicable)
Any Medical Conditions or Allergies
Special Accommodations Needed
How did you hear about the NAIDOC sport challenge?
Signature
Date signed

MonthDayYear
Date
Should be Empty: