2020 Indoor Cricket National Championships 21 & Under Mens Your Given Names Your Last Name Contacts Mobile Home Phone Player's Email Address Address Suburb Postcode State Country Date of Birth You're under the age of 18 and we need to grab some details from AT LEAST ONE of your parents. Mother's Name Mother's Mobile Mother's Email Father's Name Father's Mobile Father's Email I hereby wish to nominate my son/daughter for the 2020 Indoor Cricket National Championships. I have read the eligibility criteria and agree that I will ensure that my son/daughter abides by those conditions. I hereby wish to nominate myself for the 2020 Indoor Cricket National Championships. I have read the eligibility criteria and agree that I will ensure that I abide by those conditions. To be eligible to stand for state selection you must be a registered participant playing in the BBI/NICL. Please confirm: Eligibility Confirmation What Grade & Division have you played in BBI/NICL? Which Club did you play for? What previous representative experience do you have? Which Indoor Sports NSW Centre do you call home? Emergency Contact Given Name Last Name Contact Number Alternate Number Relationship to you Health Care Details Medicare Number Private Health Fund Member Number Ambulance Cover? YesNo General Practitioner Contact Number Medical History Do you suffer from any of the following? Asthma? YesNo If yes, what type of inhaler do you use? Diabetes? YesNo Migraines/Headaches? YesNo Allergies? YesNo If Yes - please specify what type of allergies (food, drugs, medication, etc.) Are you on any medication? YesNo If so, please advise Sporting Injuries Previous Sporting Injuries? (type and area) Strapping required before each game? Other Information Any other relevant medical information? Declaration I give my permission for ISNSW to seek appropriate medical attention if I require it. TERMS & CONDITIONS OF NOMINATING FOR STATE TEAMS 1: All current ISNSW BBI & NICL players must have met qualification requirements before trials. a) Played in the 2019 BBI/NICL competition, be financial with their club and ISNSW. b) Any players who have not played in the 2019 BBI or NICL Competition and wish to nominate can do so, however this will need to be approved by the Indoor Sports NSW Board. 2: All players who state their eligibility for a State Team, who are subsequently selected for that State Team and then withdraw from the announced team are subject to penalties as applied by the ISNSW Board. These penalties are dealt with by a case-by-case scenario but will range from loss of deposit to total suspension from any ISNSW event for twelve (12) months. 3. On selection: a) You will be required to pay a non-refundable deposit of $500 to ISNSW within 2 weeks of the team selection to secure your position in the team. Failure to do so will mean immediate removal from the State Team. b) You may be required to attend a compulsory day which will involve the completion of all tournament paperwork as well as completion of uniform order. c) You will be required to attend ALL training sessions as set down by ISNSW Coaches. If for some unforeseeable circumstances you are unable to attend, notification must be made with your Coach or Manager prior to that training session. This then will be passed onto ISNSW Board. d) If three or more training sessions are missed, you will be asked to show good reason as to why you should not be removed from the team and face further action by the NSW Board (as above). 4. All players who wish to nominate for any NSW 21 & Under Team are required to pay a $20 non-refundable nomination fee. a) If not paid, player cannot attend trials. [stripe* stripe-masters "Make Payment"] Declaration By completing this form, you are (player/parent/guardian) stating that you have read and agree to the terms & conditions above set down by ISNSW/ICNSW. DO NOT CLICK SUBMIT MORE THAN ONCE! There can be heavy traffic to join the ranks of Indoor Sports NSW! 2020ICNC21&UNDERMENS
