Thank you for expressing an interest in the Geelong Regional squads that will participate in the 2017 Country Championships.
Please note Players must be registered with a Geelong Region Club to be eligible. All players will play in their relevant age groups and only non NPL/WNPL players can register. Please note Registration for ALL Boys teams is now Closed We still require additional U12/U14/U16 Girls
Player Information:
First Name
*
Last Name
*
Date of Birth dd/mm/yyyy
*
Squad Registering For
*
U12 Girls (2005-06 Born)
U14 Girls (2003-04 Born)
U16 Girls (2001-02 Born)
Are you Registering as a Goalkeeper?
*
No
Yes
2016 Registered Club
*
FFV Number (if Known)
Address
*
Street Address
City
State
Postal / Zip Code
Parent/Guardian Information
Parent/Guardian Name:
*
Parent/Guardian Email:
*
Parent/Guardian contact #
*
Alternative email
Emergency Contact name
Emergency Contact #
Does the participant have any allergies, present medication, special considerations, etc.:
*
Yes
No
If Yes, Please Explain:
Click to submit your trial registration
Should be Empty: