Brisbane Basketball Incorporated

2015/16 Brisbane Capitals U21 Men & Women's Trials

Player/Athlete 1

Player/Athlete Details

Player/Athlete First Name

Player/Athlete Last Name

Date of Birth

Gender

Email Address

Confirm Email Address

Create your password

Enter the password that you would like to use for your new account.

Confirm your password

Home Phone

Mobile/Cell

Parent/Guardian Details

Mother's Name

Mother's Email Address

Mother's Mobile/Cell

Father's Name

Father's Email Address

Father's Mobile/Cell

Address

Address 1

Address 2

Suburb/Town

State/Prov

Zip/Postcode

Health and Fitness

Do you have any injury concerns?

Do you have any medical conditions?

Sport (if applicable)

Select one or more

U12 Boys (2006/2007/2008)

Dates

From 18-Aug-2015 to 14-Sep-2015

Days & Times

Once a time slot is full you will be asked to make another choice.

Sunday, 23-Aug-2015	01:00 PM	to 02:45 PM	NAB Court 4	U21 Men Trials (Born 1996/1997/1998)
Thursday, 27-Aug-2015	07:30 PM	to 09:00 PM	Wavell State High School	U21 Men Trials (Born 1996/1997/1998)
Monday, 31-Aug-2015	07:30 PM	to 09:00 PM	BBC	U21 Women Trials (Born 1996/1997/1998)
Thursday, 03-Sep-2015	07:30 PM	to 09:00 PM	Wavell State High School	U21 Men Trials (Born 1996/1997/1998)
Monday, 07-Sep-2015	07:30 PM	to 09:00 PM	BBC	U21 Women Trials (Born 1996/1997/1998)
Monday, 14-Sep-2015	07:30 PM	to 09:00 PM	BBC	U21 Women Trials (Born 1996/1997/1998)

DISCLAIMER:
I hereby agree to assume all risks and responsibilities surrounding my (or my child's) participation in the program under the instruction of Brisbane Basketball Incorporated coaches. I understand that similar to all sporting activities, there is a risk of damage to personal property, injury or death which may result from causes beyond the control of, and without fault or negligence of Brisbane Basketball Incorporated, its officers, agents, or employees, during the period of my (or my child's) participation. I understand completely the above agreement and agree to be bound thereby. By registering on our site you agree that we may send you email related to our facilities and programs. We will not provide your details to any other company.

Agreement

Signed

Date

/ /

Payment Method

There are no refunds for any enrolments into Brisbane Basketball Incorporated related programs. When you sign/tick confirmation for this enrolment you are acknowledging that you know this as a fact and have accepted it as a condition.

Cost

$30.00

Cost Per Person

$30.00

Total Cost

Group Discount

Promo Code

Promo Code Discount

Grand Total

Credit Card (Ezidebit)

Please mail this form with a payment attached to: "Brisbane Basketball Incorporated, Auchenflower Stadium 16 Dixon Street,, Auchenflower Queensland 4066"

2015 Rep Trials Questions

Will you be trialing with another association this season (2015/16)?

Yes
No

If you answered "Other" please provide details:

If you played for an Association other than the Brisbane Capitals last year, please complete the following questions.

If you played for an Association other than the Brisbane Capitals, have you completed a "BQ Junior Player Permission to Train Form"?

Yes
No

If you played for an Association other than the Brisbane Capitals, have you completed a "BQ Player Transfer Form"?

Yes
No