Volleyball Victoria Junior State Team Trial Registration

Gender Identity*

Male

Female

Other

Member ID (If known)

First Name*

Last Name*

Date Of Birth*

Age Group Selection*

U19

U23

What are you preferred playing positions?*

Setter

Middle

Opposite

Libero

Pass Hitter

Address*

Suburb*

Postcode*

Parent/ Guardian 1 Name*

Parent/ Guardian Email*

Parent/ Guardian Phone*

Parent/ Guardian 2 Name

Parent/ Guardian 2 Email

Parent/ Guardian 2 Phone

Athlete Email

Athlete Phone

School*

Club*

Association/ Academy*

Ambulance Cover*

Yes

No

Medicare*

Yes

No

Private Health Care*

Yes

No

Private Health Care Number

Private Health Care Fund

Medical Notes (Injury/ Illness)*

Allergies*

Dietary Requirements*

Medications*

Paracetamol*

Yes

No

Allow Medical/Physio Treatment*

Yes

No

Commitments/Holidays that may clash with the program attendance*

Previously registered to play volleyball overseas*

Yes

No

If Yes to the above - What country?

I confirm that I am born in the age groups as per the following years: U19 (2006 ONLY), U23 (2005-2002) ONLY*

Yes

Already a member?

Details

Basic details

Additional information

AGE CONFIRMATION

Already a member?

Details

Basic details

Additional information

AGE CONFIRMATION

All dates