2027 Junior Prep4Rep & Team Trial

Prep 4 Rep Program & 2027 Representative Trial
Prep4Rep:

Monday 5th October

Monday 12th October

Monday 19th October

Monday 26th October

Monday 2nd November

2027 Team Junior Trial Day

Saturday 7th November
Athletes Name

First NameLast Name
Date of Birth
What is your gender?
Contact Number
Format: 0000 000 000.
Email Address
example@example.com
Teams trialling for (please tick those that apply):
1st Preferred Position:
2st Preferred Position:
Previous Playing Experience:
Emergency Contact
Name

First NameLast Name
Relationship
Home Number
Please enter a valid phone number.Format: 0000 000 000.
Mobile Number
Please enter a valid phone number.Format: 0000 000 000.
Health Care Details
Medicare Number
Position on Card
Expires
Private Health Insurance:
Fund & Number
Private Doctor:
Phone Number
Please enter a valid phone number.Format: 0000 000 000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical History

Examples of these include but are in no way limited to: *Asthma *Diabetes *Epilepsy *Spinal Injuries *Arthritis. Please also notify us if this affects your performance.
Do you have any medical conditions that you, in consultation with your doctor, consider appropriate to notify us of prior to representative duties?

Other
If so, please provide details here:
Do you have any allergies?
If Yes Reactions/Treatment
Sports Injuries

Please describe any sports injuries have been sustained in the last 2 years: For each injury, please state type of Injury (e.g. dislocation, strain, tear, fracture) approx. date of injury and treatment received (e.g. physio, surgery)
Do you have any sports injuries?
Please list them.
Do you give permission for the coach or manager to administer Panadol to your child?

Prep4Rep

PREP4REP

(includes Trial Day Fee)

$55.00 AUD Quantity

Enter coupon

Total

Payment Methods

Credit Card

Apple Pay

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Prep 4 Rep Program & 2027 Representative Trial

Prep4Rep:

2027 Team Junior Trial Day

Emergency Contact

Health Care Details

Medical History

Sports Injuries

Prep4Rep*

Payment Methods

Prep4Rep