Exemption To Trial
Representative Basketball Trial Exemption Request Form
Athletes Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age Group Applying For:
U12
U14
U16
U18
Parents Name
First Name
Last Name
Parents Email
example@example.com
Parents Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Trial Exemption Request South West Metro Pirates expects all athletes to attend scheduled representative trials. Exemption requests are considered only under exceptional circumstances. Approval of an exemption does not guarantee selection into a representative team. Please select the reason for your request:
*
Injury or Medical Condition
State or National Sporting Commitment
School Commitment (Compulsory)
Family Emergency
Religous Commitment
Interstate/International Travel
Other
Details of RequestPlease provide a detailed explanation of why you are unable to attend the scheduled trial(s):
*
Supporting Documentation: Please attach any relevant documentation to support your application.Examples include:Medical certificate, School letter, Tournament itinerary, State or National team selection confirmation, Travel documentation, Other supporting evidence, Please Attach Document Here:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Basketball History and Current Participation - please give a brief history of your basektball achievements:
Signature
Submit
Should be Empty: