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2026 Junior State Championship Team Manager Nomination Form

Wed 22 Jul 2026 09:00 - Tue 01 Sep 2026 23:55

N/A

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Are you attending this event?

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

First Name*

Last Name*

DOB*

Email Address*

Contact Number*

Club/Association*

Emergency Contact Infomation

Please provide an emergency contact name*

Please provide an emergency contact mobile number*

Please provide an emergency contact email address*

Zone Team

Which Zone are you a team manager for?*

Which Team are you team manager for?*

Medical Conditions

Please list if you suffer from any medical conditions that your Zone should be aware of

Please list any allergies or special dietary requirements you may have

Working with Children Check (only required if 18 years or older)

Working with Children Check or VIT number

Working with Children Check or VIT expiry date

Please upload a picture (or word doc with a picture in it) of your WWCC or VIT card

Choose file...

Max 5MB

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*

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