JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2022 DISPENSATION REQUEST
Please use this form to submit a dispensation request for Senior or Youth players.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Club Requesting Dispensation
*
Choose
AISC
Auckland University
Grammar Windsor
Howick Pakuranga
Masters Women
Mt Eden
Roskill Eden
Somerville
Southern
Waitakere
Western
Name of Club Executive submitting request
*
Your answer
Contact Email 1
*
Primary contact for this request
Your answer
Contact Email 2
Secondary contact for this request
Your answer
Name of Player requiring dispensation
*
Your answer
Grades Affected
*
Please select all that apply
Premier
Premier Reserve
Division 1
Division 2
Division 3
Division 4
Youth Premier
Youth Championship
Required
Male or Female
*
Male
Female
Dispensation Request
*
Please explain why dispensation is required.
Your answer
How many players does your team have without this dispensation?
*
Your answer
Have you tried your clubs Youth players?
*
Yes
No
When do you require a response to this request.
*
As much notice as possible, preferably 2 weeks minimum, is required so that we can contact Competition Manager for approval.
MM
/
DD
/
YYYY
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Akhockey.org.nz.
Report Abuse
Forms
