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BASILDON FUTURES ACADEMY

Screening Application Form 2017 / 2018

Please complete in BLOCK CAPITALS & READ THE ACCOMPANYING INFORMATION CAREFULLY

First Name:
Surname: / Date of Birth:
All players must be aged under19 at 23:59 on 31st December 2017 i.e. born 1999 or later.
Full Address including Post Code :
Home Tel No: / Mobile No:
Email Address:
Please circle the competitions and training environments in which you have trainedand competed in during the 2016-17season
Satellite/County, Regional Academy , Regional Performance Academy, National Academy ,
Mavericks Futures, U17 Franchise Squad, U19 Franchise Squad, Franchise U21 Franchise Squad
Local League, Regional League 1 or 2 or 3, Premier League 1 or 2 or 3
Position 1 / Position 2 / EN Affiliation No:
Club Coach Recommendation and Nomination
Name:
Mobile and Email Contact details:
Club:
Signature
of Coach:
Injuries: Please state injury at time of screening, major incidents over last two season, recurring or stress problems
Medical Conditions: Please give details
Emergency Contact 1: If same as athlete please write “as above”
Name: / Relationship:
Address: / Tel Contact Numbers:

Please email completed form to: Gloria Keech-gether with £20.00 screening fee. BACS or Cheque.

Please read the important information on Sheet 2

August2017

Mavericks 2017/2018 FUTURES ACADEMY SQUAD

PLEASE READ THIS INFORMATION CAREFULLY

  • Screening to be selected into the Mavericks ‘Basildon’ Futures Academywill be held on Thursday 14th September at Basildon Sporting Village,Cranes Farm Rd, Basildon, Essex, SS14 3GR,between 6.45-9pmon one court.Registration at 6.30pm.
  • An approximate 20 PLAYERS will be named in this Mavericks Futures Academy for the 2017/2018 season (October 2017 – July 2018).
  • It is an OPEN screening and no restrictions other than a recommendation from a player’s main coach.
  • HOWEVER,ALL players must complete this form and return it if they wish to be considered.
  • The selected players will be training will be on a Thursday evening7-9pm. There will be 6additional dates TBC for match days.
  • The costs attached to this Academy is £300 which include: Thursday evening training – weekly, match day, training camps, a netball, training shirt.

You can apply to trial by completing the attached form if you meet one of the following criteria:

a)You must be affiliated to England Netball.

b)You must be aged under 19 at 23:59 on 31st December 2017 i.e. born 1999 or later.

c)You must hold a UK passport.

d)You must be able to commit to the training programme of 1 session a week.

e)Submit a £20 screening fee with the application form via a cheque made payable to “Mavericks Netball”

1 Lunedale Close, Kempston, Bedford. MK42 8JQ

or alternatively payment may be made by bank transfer to: Account Name: Mavericks Netball; Sort Code: 09-01-28; Account Number: 01724256.

f)Be able to commit to trainingfrom 5thOctober 2017.

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