Hockey SA - Pathways Exemption Form
This exemption form must be submitted before the Event or Identifying Camp. If you do not meet this timeline, submissions will not be accepted. This form does not mean you are exempt, the exemption still needs to be approved. Once a decision has been made you will be contacted via email.
Personal Information:
Name:
*
First Name
Last Name
Email:
*
example@example.com
Mobile Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
RevSport Membership no.
*
Association/club:
*
Age Group
*
Please Select
U12s
U14s
U16s
U18s
U21s
Other
Age group related to the Trial / Zone Exemption
What event are you seeking an exemption from?
*
Please Select
ZICS
ZSC
Zones
Any additional information?
Exemption Information:
Duration of the exemption?
*
Outline reason for exemption:
*
Please provide supporting documentation for exemption:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Notes:
Name of Parent/Guardian if applicant is under 18 years of age:
*
Signature
*
Supporting documents must be included
Submit
Should be Empty: