2017 Player Trials Form
Trials are being held at Goulburn Basketball Stadium and Veolia Arena on Braidwood Road
Goulburn, Saturday 3rd December 10am – 3pm cost $20 per player. Players must bring own lunch
water bottle, reversible singlet & basketball.
Name:
Address:
Suburb:
P/C:
Email:
(This is compulsory so we can send you a confirmation email)
DOB:
/
/
Age:
Gender:
Male
Female
(Please Tick a box)
Team:
U14
U16
Emergency Contact:
U18
(Please tick a box)
Phone:
I hereby consent for my child to attend the camp and permit the staff at GBA to act on my behalf should
my child require medical attention and release GBA from any liability should my child be injured. I also
permit GBA to use any photos from camp for publicity reasons.
Signed:
Receipt:
Date:
Date Paid:
If you wish to be involved in the 2017 Southern Blues CPL teams as a staff member please Contact
Rose Parmenter at [email protected]
Please return this form to Rose Parmenter PO Box 7046 Berrima NSW 2577
OR email: [email protected]
No later than Monday 28th November 2016
Basketball New South Wales
PO BOX 198
Sydney Markets NSW 2129
Tel: 02 8765 8555
Fax: 02 8765 8588
Web: www.bnsw.com.au
JUNIOR PLAYER PERMISSION TO TRIAL FORM
(PLEASE PRINT IN BLOCK LETTER)
Last name:
PLAYER DETAILS
First:
Birth date: ___ / ___ / ___
Street Address/ PO BOX:
Home:
SECTION 1
City:
Mobile:
State:
Age:
Sex:
Postcode:
Email:
I Wish to Apply for Permission To Trial in:
 Country Premier League
 Eastern Junior League
 Metro Junior League
 Northern Junior League
 Southern Junior League
 Western Junior League
I Wish to Apply for Permission To Trial at the following Association/s (Must list all Associations you are
trialing for and provide the same copy to all):
_______________________________
_______________________________
_______________________________
_______________________________
Applicants Signature:
Date:
(PLEASE PRINT IN BLOCK WRITING)
ASSOCIATION APPROVAL
Last Name:
First name:
Approval of Parent/Guardian:
Date:
SECTION 2
Association:
Certify that Permission To Trial for the above applicant has been approved between the following dates
Signed:
Position:
Date:
_____/ _____/ _____
IMPORTANT INSTRUCTIONS
1. Permission to Trial applications must be signed and returned to the player within 5 (five) Days of the permission to trial
being presented.
2. This is NOT A CLEARANCE and players may not play in any Basketball NSW conducted competitions without a
processed clearance.
3. It is recommended that all parties retain a copy of this agreement. This form does not need to be sent to Basketball NSW.