Event registration

Details

2027 U12 Representative Team Nominations

Sun 30 May 2027 8:00AM - Tue 23 May 2028 10:00AM
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State Hockey Centre, 400-420 Lytton Road, Colmslie

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Player Details

First Name*

Last Name*

Date of Birth*

Email Address (18+)*

Phone Number (18+)*

Do you require correspondence to be sent to a second email address?*

Club Information

What club did you play for in 2026?*

What division are you registered in? (This is your primary team that you play your most hockey with)*

Do you play in other divisions? (i.e. substitute/fill in)

Club playing shirt number? (for primary team)

Positional Prefences

Preferred Position 1*

Preferred Position 2

Additional Information

Did you play Outdoor Representative Hockey in 2026?*

Do you have any current injuries/medical concerns?*

Are you unavailable for any trial dates?*

Is there anything else you would like us to know? Max 255 characters

Please note

All prices are inclusive of GST.
A Nomination fee of $60.00 applies for this event.

Terms Of Registration

All players and/or officials registering or nominating for an event must be registered & financial with a BHA affiliated Club and registered & financial with the Brisbane Hockey Association and with Hockey QLD through revSport.

# I acknowledge that I have read and understood the following documents: HA Code of Conduct and Competition Rules, Section 11: Representative Program.

# I am available to attend the relevant State Championships / Coulter Shield and scheduled training / trial sessions.

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

I agree to the Terms Of Registration.*

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*

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