2022 Marie Little Shield Player Nominations

First Name

First

Middle

Last

Contact Phone Number

Contact Email Address

Address

Address 2

City/Suburb

State

Post Code

Country

What Association/Club are you currently registered with?

To be eligible for final selection, all players must be a financial member of Netball NSW prior to the Marie Little Shield trials.

Date of Birth

Height

Emergency Contact Name

First

Last

Relation to Player

Emergency Contact Phone Number

Emergency Contact Email Address

Preferred Playing Positions

Playing Experience

What is your disability?

Are there any specific conditions or other information that our support staff should be aware of?

Relevant Management Strategies/ Emergency Procedure

Sport Inclusion Australia Number

To be eligible to trial for the Marie Little Shield squad, you must meet the National Eligibility criteria as defined by Sport Inclusion Australia.

Do you suffer from any other medical condition: asthma, diabetes, allergies etc?

Yes

If Yes, please outline Details/Management 1

Is there any Medical Condition that may need reporting to a doctor?

Yes

If Yes, please outline Details/Management 2

Are you allergic to any medications?

Yes

If Yes, please outline Details/Management 3

Do you have any Special Dietary Requirements/ Food Allergies: gluten Free, vegetarian etc?

Yes

If Yes, please outline Details/Management 4

Do you have any current or previous injuries that have occurred in the last 6mths?

Yes

If Yes, please outline Details/Management 5