MIDLAND TIGERS REGISTRATION FORM

 

 

 

PLAYER DETAILS

First Name:

Last Name:

DOB:                   Phone Number:

Address:

 

EMERGENCY CONTACT

First Name:

Last Name:

Relationship:

Phone Number:

 

PLAYING HISTORY

1. Previous Club:

Last Year Played:

2. Previous Club:

Last Year Played:

3. Previous Club:

Last Year Played:

                                QUESTIONS     

Do you have any medical conditions?      Y/N   

If yes, please outline conditions:

Do you have any allergies?

If yes, please outline conditions:

Which WAFL Club do you support?

I give permission for WA Football to provide my details to my respective WAFL Club for the purposes of Talent ID and Development Squad Programs. Y/N

I give permission for Football WA to provide my details to my respective WAFL and or AFL Club in accordance with the WA Football Privacy Policy. Y/N

I give permission for WA Football to provide my details to both Western Australian AFL Clubs for the purpose of Talent ID and NGA Programs. Y/N

Do you want to be a part of the WA Footy Family and recieve WA Footy News? Y/N

Do you want to opt in to hear from WAFC partners? Y/N

Do you want to receive membership or newsletter information from your WAFL club? Y/N

If you are over 12 years of age, are you interested in Umpiring? Y/N

If yes, please let us know what discipline you are interested in below.

Boundary/Goal/Field