Details

Fri 01 Nov 2024 9:00AM — Wed 30 Jul 2025 11:59PM

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

Full Name*

Email Address*

Mobile Number*

Date of Birth*

Do you have a Blue Card/Exemption Card*

Blue Card/Exemption Card number (If no card, please type N/A)*

Blue Card/Exemption Card expiry date (If no card, please type N/A)*

Posistion Nominating For*

Coach

Assistant Coach

Manager

Age Group Nominating For*

U12

U14

U16

U18

Opens/U21

Were you a BHA Representative Official in 2024?*

If yes, what was your role and/or team in 2024? Max. 255 characters

Do you have a son in your nominated age group(s)?*

Club Affiliated with in 2024?*

Divisions Coaching/Assist Coach in 2024/25* Max. 255 characters

Coaching/Assist Coach History* Max. 255 characters

Do you want to be a Coach/Assist Coach only if your child is selected?*

Managing History (if none type n/a)* Max. 255 characters

Do you want to be a Manager only if your child is selected?*

Is there anythin you would like us to know? Max. 255 characters

Terms Of Registration

All players 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 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.*

2025 Brisbane Coach/Assist Coach/Manager Nomination

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