Please enable JavaScript in your browser to complete this form.Club NameNominated teamName of applicant player *FirstLastDoes the applicant have a government issued health care card? *YesNoIf not please provide a brief description to your knowledge of the financial hardship the family is experiencingApplicants AddressHas the club determined that the applicant could not play without support with fees.YesNoOtherAge group of nominated teamUnder 8'sUnder 9'sUnder 10'sUnder 11'sUnder 12'sUnder 13'sUnder 14'sUnder 15'sUnder 16'sUnder 17'sUnder 18'sDate of birthName of Club contactClub addressPostal address if different to aboveEmail *Phone NumberIs the applicant a new player for the club?YesNoPayments will be made by Electronic Funds Transfer (EFT) if approved to the sports club. Please provide the following bank details for payment Account NameBank account numberBSBPlay it On would like to publish the stories of the participants it helps fund and track their sporting participation. Will will use first names only in publications, do you agree to this?YesNoApplicant and Parent/Guardian acknowledgement. All the information stated in the application is the best to my knowledge true and correct. Parent/Guardian details below to confirm if deemed necessary *FirstLastContact details of parent/guardian Phone or EmailAs club contact I acknowledge to the best of knowledge the information provided here is true and correct. I certify that the player would not be able to play without this subsidy. I realise that should the applicant be successful but the player is unable or unwilling to join the club is obliged to return the full grant subsidy to Play it On. I understand and abide by the guidelines. Club contact signature and name below. *Paragraph TextParagraph TextSubmit
