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Details

2025 Under 21 State Team Trial Nominations

Mon 03 Feb 2025 18:00 — Mon 10 Feb 2025 20:00
See all dates

Perth Hockey Stadium, Perth Hockey Stadium, Hayman Road, Bentley, 6102

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Player First Name*

Player Surname*

Date of Birth*

Athlete Gender*

Player Mobile*

Player Email Address*

Residential Address*

Postcode*

Parent/Guardian Name

Parent/Guardian Contact Number

Parent/ Guardian Contact Email

Current Club*

Preferred Playing Position 1*

Preferred Playing Position 2*

PCA Skill*

PCD Skill*

Any relevant medical information we should know (allergies, medical conditions, injuries, etc) Max. 255 characters

Select registrations

U21 Men State Trial Nominations

$85.00 ea

U21 Women State Trial Nominations

$85.00 ea

Please note

All prices are inclusive of GST.

Terms Of Registration

Athletes must be or intend to be a financial playing member of an affiliated Metropolitan Club or Regional Association for 2025.

I give permission for photographs and video to be taken of me during trials and used for selection purposes as well as promotional material, including on the HockeyWA website.

As part of your selection in the team, you are required to purchase a team uniform. To enable the team's apparel provider to arrange your team uniform in your size and for you to be provided with opportunities to purchase other non-essential items of team apparel, it is necessary for the apparel provider to be able to communicate with you. To that extent, we require you to provide a mobile phone number and email address, and for your consent for Hockey WA to provide these details to the apparel provider. The apparel provider will only use these details for the purposes of contacting you in relation to the team uniform and other hockey apparel and equipment.

If for any reason you do not wish to provide your phone number and/or email address to the apparel provider, alternate arrangements will be made. Please advise if you are not prepared to provide your phone number and/or email address to the apparel provider so that alternate arrangements can be put in place.

All expenses will be the responsibility of the player with full payment required before the tournament begins.

I confirm that I have read the above Terms Of Registration in its entirety.*

I agree to the Terms Of Registration.*