Water Polo Interstate Nomination

Enter your details and press submit at the bottom of page. Please do not print a blank form and hand write your details as your nomination will not get through to the sport coordinator.

Interstate Trial Nomination Form 2012

School Details:

School Name:
Suburb:
School Phone:

Competitor Details:

First Name:
Surname:
Email Address:
Important: All relevant sport information and competition updates will be sent to this email address:
Contact No:
Parent / Guardian Details
First Name:
Surname:
Email Address:
Contact No:
Principal Authority: A condition of participation is schools compliance with Department of Education Policies and Guidelines as they relate to excursions. My school Principal is aware of, and endorses, this nomination. Yes (Please click) Principal's Signature:____________________________________ Please print this nomination form and present to your Principal for authorisation. To participate in the trials a copy of the form, with Principal's signature, must be presented on the day of the trial.

Competition Details:

Male: Female:

Current Water Polo Club:
Current Coach:
Coach Contact Number:
Nominated Positions:	1. 2.

I wish to be considered for selection in the State Schoolboys/Schoolgirls Water polo Team and agree to abide by the decisions of the selectors.

(Please Click)

Nominations Due: Fri 10th February 2012

Nomination Fee: $25 per person

Please bring money with you on the day of the trial. Cheques made payable to School Sport WA

When you submit this form it will be emailed to the Sport Coordinator.

Gemma Hadley

Balga SHS

gemma.hadley@det.wa.edu.au

For your records please print a copy of the form before submitting

For security reasons we require you to enter a code word prior to hitting the submit button.

Code Word [use lowercase]: sswa Enter code word here