Highlands Soccer Association (Inc.)
ABN: 71 417 273 069
Assoc. No: Y0535926
Application for dispensation to play above age group
Club (applicant): ____________________________________________________________________________________
Please consider granting the following dispensation in accordance with the applicable playing Rules.
We as Head Club Coach, Team Coach and Parent/Legal Guardian have assessed the player’s suitability and accept the
responsibility for playing this player above their applicable age group.
Eligible grade:
Junior (12 - 15 yrs this calendar year)
SSF (5 – 11 yrs this calendar year)
(Tick Box)
Male
Female
Player Name: ____________________________________________________________________________________
D.O.B. ____/____/______
Address:_________________________________________________________________________________
Parent/Legal Guardian contact phone(s):_______________________________________________________
Email:___________________________________________________________________________________
Competition level (age/grade requested to play in): ______________________________________________
Reason dispensation requested (see below for acceptable guidelines)
…………………………………………………………………………………………………………………………................................................................
……………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………
Other competition level(s) recently played in:
Club/Comp/Grade: ____________________________________________________________Year: ________________
Team Coach (sign): ________________________________________
(print name): _______________________________
Club Head Coach (sign): ____________________________________
(print name): _______________________________
Parent/Guardian (sign): ____________________________________
(print name): _______________________________
When you have completed this form, please forward to: HSA Manager – E: [email protected]
This form will be returned to applicant Club within 14 days marked/signed as Approved/Declined/ On Hold pending further information or assessment.
HSA reserves the right to review or reverse any dispensations granted at any time.
For office use only:
On behalf of HSA, I have considered the merits of this application and made the following decision:
This application has been Approved / Declined / placed On Hold pending more information:
(circle appropriate decision and strike through non-applicable decisions)
Comments/Info requested:_____________________________________________________________________________
Director of Operations (sign): ___________________________ (print name): ___________________________Date: _________
All Correspondence for the HSA Inc. to: PO Box 2221, Bowral, NSW 2576
Manager:
Chairman:
Director Of Operations:
Website:
www.hsa.org.au
Michael Hamilton
Leon Smith
Ian Campbell
M: 0448 184646
M: 0423 078279
M: 0418 485 643
[email protected]
[email protected]
[email protected]
Highlands Soccer Association (Inc.)
ABN: 36 684 709 559
Assoc. No: Y0535926
Guidelines for application for dispensation to play out above age group
1. The Rules referred to within this document may include HSA Local Cup and Competition Rules, STFA/HSA Joint
Competition Playing Rules, HSA By-Laws and any other applicable playing rules or by-laws.
2. Clubs having two or more teams in a junior competition age group shall before the players play the current
season, nominate players into teams as they so choose for the duration of the season (eg: U12A, U12B, U12C etc)
3. Players must register in their correct age group in accordance with the Rules unless dispensation to play above
their age group is approved by HSA (eg: a 10 year old player wishing to play U12 or a 13 year old player wishing
to play U15 etc).
4. A player may play up one (1) age grade above their age in the current calendar year without need for application
for dispensation.
5. A copy of a dispensation form signed by the intending Team Coach, Club Head Coach & the player’s Parent/Legal
Guardian acknowledging they have assessed the player’s suitability to play above their age group, and have
agreed to lodge a dispensation application, must be forwarded to HSA.
6. A player seeking dispensation to play above their age in the current calendar year must have their dispensation
approved by the HSA before playing above their eligible age group in accordance with the Rules.
7. Generally, dispensations will only be approved in exceptional circumstances, the most likely being to provide
challenges for higher level players.
8. For higher level players the following criteria will considered by the HSA. Such criteria must be evaluated and
addressed by the players Team Coach & Club Head Coach for consideration where applicable:

Can the player cope physically?, and

Can the player cope physiologically?, and

Is the player’s safety at risk?, and

Can the player cope technically and tactically?
9. Should the parties wish to appeal the decision of HSA, they must follow the appeal procedure set out in the
Rules. In any event, appeals must be lodged with HSA via the HSA/HFC Manager
E: [email protected]
10. No dispensations will be given to regrade players down an age group without extremely exceptional
circumstances which must be put in writing and with supporting third party professional documentation
specifically addressing the regrade merits.
11. All documentation and information provided to HSA for dispensation applications will remain confidential.
12. Applicants can expect approx 2 week processing time for each application.
Issued: 050313
All Correspondence for the HSA Inc. to: PO Box 2221, Bowral, NSW 2576
Manager:
Chairman:
Director Of Operations:
Website:
www.hsa.org.au
Michael Hamilton
Leon Smith
Ian Campbell
M: 0448 184646
M: 0423 078279
M: 0418 485 643
[email protected]
[email protected]
[email protected]