Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

D.O.B:*

Emergency Contact Info (Name, Mobile & Email)*

Medicare Card #, Patient # and Expiry*

Private Health Details, or Ambulance Cover Details (if covered)

It is recommended that all HockeyAW members be covered by adequate medical and hospital insurance in addition to the basic accident insurance provided by Hockey Australia.*

I acknowledge the above statement

Do you have any allergies? (Please include medications, tapes, foods etc)* Max 255 characters

Have you ever had any of the following?*

High Blood Pressure

Heart Condition or Heart Issues

Asthma

Epilepsy or fainting episode of any kind

Mental Health Condition

Any of illness or injury (please lest details below)

None of the above

Details of other illness or injuries Max 255 characters

Is there anything else that we need to be aware of regarding your health and well-being?*

Yes

No

I am aware that I am responsible for the full payment of my fee's to HockeyAW. Failure to do so within the required timeframe will result in being ineligible for future rep carnivals, as well as local competition.*

I understand and agree to this statement

Do you agree to your photo being shared on social media?*

Yes

No

Select tickets

NSW State Champs

$222.00 ea

Event Waiver

Photo Sharing

My photo may be taken and shared throughout the Carnivals, these photos may be action shots whilst playing or individual photos for BOG awards etc. If I do not agree to my photo being shared, I understand that it is my responsibilty to reach out the the Manager and Coach of my Team to discuss the acceptable levels of my photo sharing.

Hockey World Discount

Please note: All Junior Spitfires Squad Members are entitled to a 30% discount in the Hockey Shop. This is part of the ongoing agreement that HockeyAW has with Hockey World. Feel free to reach out to Merryn and Tony with any equipment needs.

I confirm that I have read the above Event Waiver in its entirety.*

I agree to the Event Waiver.*

Event registration

Already a member?

Details