All Abilities - Indoor Volleyball Program Athlete InformationName* First Last Gender*Please SelectFemaleMaleWhat is your age?*Date of Birth* DD slash MM slash YYYY Email* Enter Email Confirm Email Mobile*Address* Street Address City ZIP / Postal Code Local Government*What Local Government Area do you reside in? City of Canning City of Melville City of South Perth Town of Victoria Park Volleyball WA Membership Status*What is your current Volleyball WA Membership Status? Platinum Gold Silver No Membership Emergency Contact InformationEmergency Contact Full Name*Emergency Contact Relationship*Emergency Contact Email* Emergency Contact Mobile*Medical Notes (All Abilities program is for participants with a physical, intellectual or sensory disability only)*Medical Disability: Eg. Physical or Mobility issues; Vision difficulties; Hearing difficulties; Sensory or Neurological difficulties; Learning difficulties; etc.Support Person or AssistanceWill you have a support person attending the session or will you need assistance at the session? Yes - a support person will be attending Yes - assistance is needed No Level of Fitness/Participation*What is your level of fitness or sport participation? Eg. First time playing a sport; Played a little bit of social sport; Played competitive sport; Played high performance sport; etc.Are you an NDIS Participant* Yes No Association RequirementsReds Membership Agreement*I have read and agree to comply with the Reds Membership Agreement. Yes Policies*I agree to comply with all Association and Club policies. Yes Associate Member*I understand that by completing this membership I will become an Associate Member of the Perth Reds Volleyball Association and the Reds Volleyball Club. Yes HOME
