Basketball Application Form 26

Basketball Athlete Nomination Form 2026
Applications close on Monday 13th October 2025.

For further information or queries please contact the NIAS Office on 02 6766 2526 or email admin@nias.org.au

Athlete Information
Name*

First NameLast Name
Birthdate*

DayMonthYear
Date
Gender*
Are you of Aboriginal or Torres Strait Islander Descent*
Athlete Email*
example@example.com
Athlete Mobile Number
Please enter a valid phone number.
Address*

Street Address

Street Address 2

TownState

Postcode
Council LGA*
School*
e.g. Tamworth Public or Oxley High
Shirt size*

Parent/Guardian Contact Details
Parent Name*

First NameLast Name
Parent Phone Number*
Please enter a valid phone number.
Parent Email*
example@example.com
Second Parent Name

First NameLast Name
Second Parent Phone Number
Please enter a valid phone number.
Second Parent Email
example@example.com
I give permission for my child to be photographed at NIAS activities for promotional purposes*

I give permissionI do not give permission

Medical Details
Emergency Contact*

First NameLast Name
Emergency Contact Mobile Phone Number*
Please enter a valid phone number.
Permission to call ambulance?*
Medicare No.*
Private Health Fund Name (If applicable)
Fund Member Number
Do you have ambulance cover with private health?

YesNo
Do you have any medical conditions?*
If yes, please specify.
Do you have any ongoing/chronic injuries?*

Sport Information
Current Club/Association*
Highest level of representation/competition and result*
How long have you played/competed for?*
What are your sporting goals?*
Please upload a letter of recommendation from a current coach and/or PE teacher. *

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Please verify that you are human*
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