20_______ FOOTBALL SEASON
APPLICATION FOR MEMBERSHIP
1. CLUB NAME:
SECTION 2: MEMBERSHIP DETAILS
I hereby apply for membership of the above mentioned club, an affiliate of the West Perth District Football Development Council. I have read, understand,
acknowledge and agree to the declaration over leaf. I have signed the declaration and application.
INITITIAL MEMBERSHIP
RENEWING
TRANSFERRING* FROM ______________________ CLUB
* Transferring members must complete the transfer process which may include an additional transfer form – please speak with the club you are leaving.
AGE CATEGORY: I am applying for membership in the following age category:
NAB AFL AUSKICK:
Pre-Primary
Year 1
Year 2
Year 3
MODIFIED COMPETITION: Year 4
Year 5
Year 6
Year 7
YOUTH COMPETITION:
Year 9
Year 10
SECTION 3: PLAYER DETAILS
Year 8
FIRST NAME:
SECOND NAME:
Year 11
Year 12
SURNAME:
STREET ADDRESS:
SUBURB:
POST CODE:
POSTAL ADDRESS:
SUBURB:
POST CODE:
(if different from above)
DATE OF BIRTH:
BIRTH CERTIFICATE / PASSPORT NUMBER:
GENDER:
MALE
FEMALE
(Must be sighted for initial registrations)
SCHOOL:
SCHOOL YEAR:
BACKGROUND DETAILS: Please note this information will be used for statistical purposes only.
COUNTRY OF BIRTH:
DO YOU SPEAK ANY LANGUAGES OTHER THAN ENGLISH AT HOME?
Yes
ARE YOU OF ABORIGINAL OR TORRES STRAIGHT ISLANDER DESCENT?
No
If Yes, please list language/s:
Yes
No
SECTION 4: PARENT & EMERGENCT CONTACT DETAILS
PARENT/GUARDIAN #1
SURNAME:
RELATIONSHIP (i.e. Mother/Father):
FIRST NAME:
HOME PHONE:
SECOND NAME:
MOBILE PHONE:
EMAIL:
PARENT/GUARDIAN #2
SURNAME:
RELATIONSHIP (i.e. Mother/Father):
FIRST NAME:
HOME PHONE:
SECOND NAME:
MOBILE PHONE:
EMAIL:
Parent participation is vital for the success of Junior Football and is a requirement for all parents. I am able to assist with:
Coaching
Manager
Committee
Match Day
First Aid
Time Keeping
Canteen
(may include Runner, Water Carrier, Boundary Umpire, Goal Umpire)
Sponsorship is vital to the future success of our club. Are you interested in assisting as a club sponsor?
Yes
No
SECTION 5: MEDICAL DETAILS
Are there any medical conditions, illness, injury, disability or allergies the club or coaching staff should be aware of? If you answer yes, please provide details:
Yes
No
Completion and lodgement of this Registration Form indicates acceptance that in an emergency, it might be necessary to arrange medical treatment for your
child on your behalf where a parent or guardian is not present and where prior notification has not been possible.
SECTION 6: UMPIRING
Umpires are an important part of our game. Would you like to earn money by Umpiring Junior Football (must be 14 years of age by June 30th of the current
season)
Yes
No
PRIVACY POLICY
Personal information collected by the Junior Football Club is for the primary purposes of membership requirements, competition purposes and football
development. It will not be released for any form of commercial gain and will be maintained in a secure environment as per the requirements of the Privacy Act.
Completion and lodgement of this Registration Form indicates acceptance of this policy.
I am aware that a team photograph or other image may be produced during the football season by a club or governing body and may be utilised for the
promotion and development of football by the governing body.
I am aware that recording images of children participating in football both photographic and video graphic is not permissible without the consent of the child’s
parent or guardian.
CODE OF CONDUCT
Completion and lodgement of this Registration Form indicates acceptance of the following code of conducts:
PARENT’S & SPECTATOR’S CODE OF CONDUCT
•
Understand and adhere to BYLAW #1 ‘The Spirit of Junior Football’.
•
Encourage children to participate, if they are interested.
•
Encourage children to always participate according to the rules.
•
Never ridicule or yell at a child for making a mistake or losing a game.
•
Remember that children learn best from example. Applaud good plays by all teams.
•
If you disagree with an official, raise the issue through the appropriate channels rather than questioning the official’s judgment and honesty in public.
•
Support all efforts to remove verbal and physical abuse from sporting activities.
•
Recognize the value and importance of volunteer coaches, managers and helpers
•
Remember that children play organized sports for fun. They are not playing for the entertainment of spectators only, nor are they miniature
professionals.
•
Condemn the use of violence in any form, be it by spectators, coaches, officials or players.
•
Encourage players to follow the rules and the umpire’s decisions.
•
Demonstrate appropriate social behaviour by not using foul language, harassing players, coaches, umpires or volunteers.
PLAYER’S CODE OF CONDUCT
•
Understand and adhere to BYLAW #1 ‘The Spirit of Junior Football’.
•
Play by the rules.
•
Never argue with an official. If you disagree, discuss the matter with your coach or teacher after the game.
•
Control your temper. Verbal abuse of officials or other players, or provoking an opponent is not acceptable.
•
Work equally hard for yourself and for your team. Your team’s performance will benefit so will you
•
Be a good sport. Applaud all good plays whether they are by your team, opponent or the other team.
•
Treat all players as you would like to be treated. Do not interfere with, bully or take unfair advantage of another player.
•
Cooperate with your coach, team mates and opponents. Without them there would no competition.
•
Play for the “fun of it” and not just to please parents and coaches.
•
Avoid using derogatory language.
•
Be prepared to take responsibility for your actions.
WAIVER & INDEMNITY
Football - Means Australian Rules Football
Club - Means the Football Club
League - Means the Football League
Child - Means child or ward
I am aware that playing Football, observing Football, learning to play Football and training to play Football, and participating in any activity carried out by the
Club, are activities that inherently involve risk, and that in undertaking the activities my child does so at his/her own risk.
I am also aware that, as a condition of my child’s admission to membership of the Club, its office bearers, officials, coaches, managers, umpires, members,
and/or agents are absolved from all liability arising from injury or damage howsoever caused. That injury or damage may arise out of member-ship of the Club,
playing Football, observing Football, learning to play Football and training to play Football, or negligence of any nature whatsoever on the part of the Club or
League, their representatives, office bearers, officials, coaches managers, umpires, members, and/or agents.
I understand and agree that nothing in this agreement purports to exclude any liability that may be owed by the Club or the League and their representatives
pursuant to the provisions of any relevant Statutory Act/s covering these activities. To the extent that any part of this agreement may contravene any of the
Statutory Act/s I agree that part of the agreement may be severed and rendered void but the rest of the agreement will remain valid and continue to have
effect.
INSURANCE
The Club has, as per League requirements and guidelines basic Sports Injury Cover and Public Liability Cover. As a member I understand that I am encouraged to
seek Private Health Insurance and Ambulance Cover. For specific information about insurance please contact the club secretary.
MEMBERSHIP AGREEMENT
I Do hereby acknowledge that of my own free will and desire, I have contracted with the Club for the instruction, training and playing of my child in Football and
that I have read and understood the above waiver, privacy policy, code of conducts and insurance information.
Member Name:
Parent/Guardian Signature:
Date:
Parent Guardian Name:
OFFICE USE ONLY
Date Application Received:
Membership:
Accepted
Comment/Notes:
Amount Paid:
Sporting Pulse Entry Date:
Signature of Club Officer:
Rejected
Receipt Number: