Print the Application form - Maribyrnong Sports Academy ...

M a r i b y r n o n g S p o r t s A c a d e m y
ATHLETE APPLICATION
ATHLETE NAME: (Block letters) ____________________________ _________________________
Surname First Name
SPORT(S) ______________________________________________ Year Level in 2014: ___________
Gender: MALE [ ] FEMALE [ ] Date of Birth: / /
Address: _______________________________________________________________
Suburb _______________________________ Postcode ______________
Home Phone: ______________________ Athlete Mobile: ___________________
Athlete Email: Height: (cms) Weight: (Kg)
Address: ____________________________________________________________________________
Suburb ____________________________________ Postcode _________________
Home Phone: _________________ Work Phone:__________________ Mobile: __________________
Mothers Email :
Address: ____________________________________________________________________________
Suburb ____________________________________ Postcode _________________
Home Phone: _________________ Work Phone:__________________ Mobile: __________________
Fathers Email:
Emergency Contact Name: ____________________________________
Relationship to Athlete: ______________________________________
Home Phone: Work Phone: Mobile Phone:
Preferred email for Sports Academy Messages: _________________________________________________
Preferred Mobile for SMS messages: ______________________________
ATHLETES WITH A DISABILITY - PLEASE COMPLETE THIS SECTION ALSO.
Disability: ____________________________........ Classification: __________________________
Pensioner: ______________________________
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