Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Contact Details

Player First Name*

Player Surname*

Player DOB*

Player Address*

Guardian Name*

Guardian Mobile*

Guardian Email

Does the player have another Primary guardian*

Yes

No

Guardian #2 Name

Guardian #2 Mobile

Guardian #2 Email

Hockey Details

Registered Club*

Banks Hockey club

Commerce Pints Hockey Club

Nightcliff Tigers Hockey Club

Palmerston Saints Hockey Club

East Darwin Hockey Club

Waratah Hockey Club

If other, please list Club and State*

Preferred Playing Position #1*

Preferred Playing Position #2*

Do you have any preexisting/current injuries or illness?*

If yes, please provide details* Max 255 characters

Trials

I will attend both Trials*

Yes

No

If no, I am unable to attend one or both trials and will request an exemption from Hockey NT

Yes

I have read and understand the Social Media Policy*

Yes

I have read and understand the Player Code of Conduct*

Yes

Players email address

Players Contact Number*

Please note

All prices are inclusive of GST.
A Booking fee of $50.00 applies for this event.

Terms Of Registration

Waiver

To be eligible for selection, the Player Nomination must be completed, along with payment of the $50.00 Nomination fee.

If you are currently unfinancial with Hockey NT, your nomination may not be accepted.

Hockey NT will also confirm your financial status with your Club. If you are deemed to be unfinancial you will be contacted accordingly.

I confirm that I have read the above Terms Of Registration in its entirety.*

I agree to the Terms Of Registration.*