[md-form]
[md-text label="Player's First Name"][/md-text]
[md-text label="Player's Last Name"][/md-text]

[md-card title="Contacts"]
[md-text label="Mobile" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="Home Phone" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="Player's Email"][/md-text]
[/md-card]

[md-card title="Address"]
[md-text label="Address"][/md-text]
[md-text label="Suburb" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="Postcode" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="State" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="Country" desktopwidth="6" tabletwidth="4"][/md-text]
[/md-card]

[md-text label="Date of Birth"][/md-text]

[md-card title="Parental Contacts"]
[md-text label="Mother's Name" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="Mother's Mobile" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="Mother's Email"][/md-text]
[md-text label="Father's Name" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="Father's Mobile" desktopwidth="6" tabletwidth="4"][/md-text]
[md-text label="Father's Email"][/md-text]
[/md-card]

[md-select label="Selected Team:"]
12&U Girls14&U Girls16&U Girls16&U Mixed
[/md-select]

[md-card title="Bank Details for Refund"]
[md-text label="Account Name"][/md-text]
[md-text label="BSB"][/md-text]
[md-text label="Account No."][/md-text]
[/md-card]

[md-grid]
[md-accept terms="By completing this form, you are (player/parent/guardian) declaring that the information supplied above is correct, and you are authorized to apply for a refund of player fees for the 2020 INA Junior National Championships, as determined by ISNSW/INNSW." label="Declaration"]

[/md-accept]
[/md-grid]

[md-submit]

[/md-submit]

[/md-form]