2019 Victorian Wheelchair Football League - Expression of Interest

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Thanks for your interest in the 2019 season of the Robert Rose Foundation Victorian Wheelchair Football League.

Please complete the form below with your details.

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* 1. Name:

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* 2. Gender:

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* 3. Mobile:

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* 4. Email:

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* 5. DOB:

Date of Birth

Date

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* 6. Where do you live?

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* 7. Which AFL club do you support?

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* 8. I am interested in becoming:

A Player

An Umpire

A Coach

A Volunteer

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* 9. Do you identify as having a Physical Disability and/or Impairment?

Limb loss or limb deficiency

Hpyertonia, Ataxia, Athetosis or Dystonia

Short Stature

Muscle weakness

Joint movement restrictions

Limb length difference

Spinal cord injury

No, I do not identify as having a Physical Disability and/or Impairment

If appropriate, please state the nature of your disability and/or impairment (i.e. Spina Bifida, Cerebral Palsy, Paraplegic etc.)

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* 10. Did you participate in the inaugural season of the Victorian Wheelchair Football League?

Yes

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* 11. Have you previously played other wheelchair sports?

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* 12. Do you own a Sports Wheelchair?

Yes

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* 13. How did you find out about the Victorian Wheelchair Football League?

Facebook

Twitter

Word of mouth

Wheelchair Sports Day

Community Festival

Disability Sport & Recreation

Promotion through an AFL Club

Radio

Other (please specify)

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* 14. Will you attend the Open Skills Session on Sunday 24 February 2019, 10am to 3pm at Darebin Community Sports Stadium?

Yes

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* 15. Will you attend the Draft Combine on Sunday 3 March 2019, 10am to 3pm at Boroondara Sports Complex?

Yes

Thanks for submitting your Expression of Interest we will be in contact soon with more information about the 2019 Robert Rose Foundation Victorian Wheelchair Football League season, and all of our upcoming events!

For more information please contact Scott Nicholas, AFL Victoria Disability Programs Manager on 0436 434 556 or scott.nicholas@afl.com.au.