Football West State Boys trials for U14s and U15s

Player Information
Please enter the following details for the registering player.
Player Name*
First Last
Date of Birth
Email Address*
Mobile Number
Please select the age group you are trialing for:
Club and Playing Information
Please provide the club and playing information in relation to the player listed in this registration.
Name of Club
Select Preferred Position
Are you trialing for a goalkeeper position?
Do you have any current injuries?
If yes, please provide details of your injury:
Do you have any holidays booked in the lead up to the tournament?
If yes, please provide details of your holiday:
Player Medical Information
Please provide the medical informaition in relation to the player listed in this registration.
Does the player have any medical conditions?
If yes, please check all the applicable boxes below:
- Respiratory Problems
- Diabetes
- Headaches/Migraines
- Skin Problem
- High Blood Pressure
- Epilepsy
- Eye/Ear problem
- Emotional Illness
- Asthma/Bronchitis
- Allergies (mild-severe)
- Digestive Disorder
- Other
- Not Applicable
If other, please specify:
Please provide any further medical information you feel will be of assistance:
Parent / Guardian Information
Please provide the name and contact information of a person we can contact in the event of an emergency.
Parent / Guardian Name
Parent / Guardian Email
Parent / Guardian Mobile

Player Information