Under 18 Representative Trial Exemption Form

Parents/Guardians should use this form if their child is unable to attend one or more of the scheduled representative trials. Please note non attendance to trials will affect which team your child may be selected to. Please contact the Brisbane Basketball office for further information.

* 1. Players Full Name:

* 2. Current Club Team:

* 3. Please outline below in detail reason(s) for exemption request (note: exemptions are considered on a case-by-case basis based on extenuating circumstances as outlined in section 8 of the Brisbane Capitals Representative Program - Team Selection Policy. These include 1. Injury or illness, 2. Travel & Travel Delays, 3. Significant Equipment Failure, 4. Bereavement or Personal Misfortune):

If you are applying on medical grounds you must submit a doctor's certificate when requested.

* 4. Outline the dates unable to attend (and the corresponding trial event - i.e. June 15th - July 3rd, Trial #2):

* 5. Age Group Trialing For:

Under 12 Boys
Under 12 Girls
Under 14 Boys
Under 14 Girls
Under 16 Boys
Under 16 Girls
Under 18 Boys
Under 18 Girls
Under 21 Men
Under 21 Women

* 6. Parent/Guardian Name:

* 7. Parent/Guardian Contact Email (please check for correct spelling):

* 8. By completing this exemption request you acknowledge that each request is considered on a case-by-case basis weighed against the extenuating circumstances listed in the Brisbane Capitals Representative Program - Team Selection Policy (section 8). BBI reserves the right not to approve requests that do not satisfactorily meet the criteria outlined in the Team Selection Policy (section 8).

Yes

* 9. Parent/Guardian Signature (Please use your mouse pad to sign your signature in the space provided. If you have a touch screen, you will be able to use your finger):