55 Cardigan St,
Angle Park SA 5010
PO Box 2352,
Regency Park, SA 5942
Phone: (08) 8243 7100
Fax: (08) 8268 2870
Website: www.grsa.com.au
Email: [email protected]
APPLICATION FOR REGISTRATION
I hereby apply for registration with Greyhound Racing SA as (Tick “√”one only):Section
Licence
Practical required
$
B.
Attendant
Yes
19.00
C.
Owner/Attendant
Yes
19.00
D.
Owner/Trainer
Yes
28.00
E.
Public Trainer
No
50.00
F.
14 to 16 Attendant
Yes
7.00
1 Yr
3 Yrs
5 Yrs
***New Owner/Trainer applicants ONLY are required to purchase a Greyhound Racing –
Get Involved DVD for $10.00 as part of their licence application***
*This information is provided in accordance with the provision of GRSA’s Privacy Policy*
FULL NAME .........................................................................................................................................................................................
DATE OF BIRTH: ...................................................................... OCCUPATION: ...............................................................................
RESIDENTIAL ADDRESS: .................................................................................................................................................................
........................................................................................................................................... POSTCODE: .............................................
POSTAL ADDRESS: ............................................................................................................................................................................
........................................................................................................................................... POSTCODE: .............................................
PH (H) ............................................ (Wk) ....................................... (Mobile) ......................................... (Fax) ......................................
HEREBY apply for registration as indicated above with Greyhound Racing SA(referred to as GRSA from this point forward) and I
acknowledge that any registration issued to me is subject to the following conditions.
1.
That I will agree to be bound by and comply with all such Rules and Statutory provisions in respect of greyhound racing and the
registration of persons as shall for the time being and from time to time be in force and that the registration may be revoked at any
time by GRSA in accordance with the Rules of Greyhound Racing.
2. That I shall be bound at all times by the said Rules and the Rules of a Club registered by GRSA and the Rules of any body
declared by GRSA to be an Approved Registration Authority.
3. That I will comply with any directions which may be given by GRSA or the Stewards.
ALL THE FOLLOWING QUESTIONS MUST BE ANSWERED
Have you previously been registered with GRSA or any other Greyhound, Thoroughbred or Harness Racing authority YES / NO
Name of Racing Body ...............................................................................................................................................................................
Type of registration ................................................................................................. Year of expiry ..........................................................
Have you ever been refused registration or had a licence revoked or cancelled by any Greyhound Registration Authority or
Thoroughbred or Harness Racing Authority? YES / NO
If YES please give details .........................................................................................................................................................................
..................................................................................................................................................................................................................
Have you ever been suspended, disqualified, warned off, fined or listed as a defaulter for any reason with GRSA or any other
Greyhound, Thoroughbred or Harness Racing Authority or any other sport? YES / NO
If YES please give details .........................................................................................................................................................................
..................................................................................................................................................................................................................
Have you ever been convicted for any offence punishable by fine or imprisonment or both? (Traffic offences excepted) YES / NO
If YES, ‘Give details of Offence. Please supply in a sealed envelope marked, Strictly Confidential, and address to Chairman of
Stewards. NOTE: May be required to supply copy of National Police Report.
THERE ARE FURTHER CONDITIONS TO BE ACKNOWLEDGED OVERLEAF
FOR OFFICE
USE ONLY
RECEIVED
RECIEPT NO.
DATE ISSUED
LICENCE NO.
PAID $
SECTION A: TO BE READ BY AN APPLICANT SEEKING REGISTRATION AS AN OWNER
In making an application for registration as an Owner with GRSA I acknowledge that any registration issued to me is
subject to the following conditions:
1) I have read and understand the conditions on the front page.
2) That I will notify GRSA within 48 hours the names of all greyhounds owned by me and of greyhound’s which have
been transferred from my ownership.
3) That I will notify GRSA forthwith of any change (temporary or otherwise) to my address.
4) That I will undertake to notify GRSA in writing within 48 hours of any change in the answers given to questions or
details submitted in this application that may affect the continuance of such registration.
5) That I acknowledge that this registration allows me to race a greyhound/s as an Owner and such greyhound/s will be
trained for racing by a person/s registered with an approved registration authority.
6) That I am not permitted to handle greyhounds.
SECTION B: TO BE READ BY AN APPLICANT SEEKING REGISTRATION AS AN ATTENDANT
(Applicant must be no less than 16 yrs of age)
In making an application for registration as an Attendant with GRSA, I acknowledge that any registration issued to me is
subject to the following conditions:
1) I have read and understand the conditions on the front page.
2) That I will notify GRSA forthwith of any change (temporary or otherwise) to my address.
3) That I will only be permitted to handle greyhounds.
4) That I will undertake to notify GRSA in writing within 48 hours of any significant change in the answers given to
questions or details submitted in this application.
5) I have completed and attached the appropriate questionnaire with this application.
6) Four (4) Passport photographs (32mm x 25mm) must accompany this application along with proof of identity.
SECTION C: TO BE READ BY AN APPLICANT SEEKING REGISTRATION AS AN OWNER/ATTENDANT
(Applicant must be no less than 16 yrs of age)
In making an application for registration as an Owner/Attendant with GRSA I acknowledge that any registration issued to
me is subject to the following conditions:
1) I have read and understand the conditions on the front page.
2) That I undertake that in the event of registration being granted to me to observe the following conditions when
exercising greyhounds in any public place, street or park.
a) Such greyhounds shall be properly muzzled and on a leash.
b) One person shall not exercise more than four greyhounds at any one time.
c) No greyhound shall be exercised in any public park without consent.
3) That I will undertake to notify GRSA in writing within 48 hours of any change in the answers given to questions or
details submitted in this application that may affect the continuance of such registration.
4) That I will notify GRSA forthwith of any change (temporary or otherwise) to my address.
5) That I will notify GRSA within 48 hours the names of all greyhounds owned by me and of greyhound’s which have
been transferred from my ownership.
6) I have completed and attached the appropriate questionnaire with this application.
7) Four (4) Passport photographs (32mm x 25mm) must accompany this application along with proof of identity.
SECTION D: TO BE READ BY AN APPLICANT SEEKING REGISTRATION AS AN OWNER TRAINER
(Applicants must be no less than 18 yrs of age)
A COPY OF NATIONAL POLICE REPORT IS REQUIRED WITH THIS APPLICATION
In making an application for registration as an Owner/Trainer with GRSA I acknowledge that any registration issued to
me is subject to the following conditions:
1) I have read and understand the conditions on the front page.
2) That I undertake that in the event of registration being granted to me to observe the following conditions when
exercising greyhounds in any public place, street or park.
a) Such greyhounds shall be properly muzzled and on a leash.
b) One person shall not exercise more than four greyhounds at any one time.
c) No greyhound shall be exercised in any public park without consent.
3) That I will notify GRSA of the names of all greyhounds domiciled in my kennels for a period exceeding 48 hours and
to notify GRSA in writing within 7 days of the names of all greyhounds removed from my kennels.
4) That I agree to open my kennels for inspection and photographing at any reasonable time by an authorised officer of
GRSA.
5) That I will notify GRSA forthwith of any change (temporary or otherwise) in the address of my kennels or my
residence.
6) That I will at all times keep and maintain greyhounds domiciled on my premises and/or for which I am responsible in
good condition and provide such greyhounds with proper accommodation, kennelling, food and clothing in
accordance with the standard usually provided or supplied in connection with the training of greyhounds.
7) That I will undertake to notify GRSA in writing within 48 hours of any significant change in the answers given to
questions or details submitted in this application that may affect the continuance of such registration.
8) That I acknowledge that this registration allows me to only train greyhounds registered in my name or of which I am
Part Owner.
9) I have completed and attached the appropriate questionnaire with this application.
10) Four (4) Passport photographs (32mm x 25mm) must accompany this application along with proof of identity.
SECTION E: TO BE READ BY AN APPLICANT SEEKING REGISTRATION AS A PUBLIC TRAINER
(Applicants must be no less than 19 years of age and have held an Owner Trainer’s licence for at least 12 months)
In making application for registration as a Public Trainer with GRSA I acknowledge that any registration issued to me is
subject to the following conditions:
1) I have read and understand the conditions on the front page.
2) That I will notify GRSA of the names of all greyhounds domiciled in my kennels for a period exceeding 48hrs and
will notify GRSA in writing within 7 days of the names of all greyhounds removed from my kennels. (Brood Bitches
and Stud greyhounds excluded.)
3) That I undertake that in the event of registration being granted to me to observe the following conditions when
exercising greyhounds in any public place, street or park.
a) Such greyhounds shall be properly muzzled and on a leash.
b) One person shall not exercise more than four (4) greyhounds at any one time.
c) I will ensure that a person under the age of 16yrs shall not lead greyhounds for me unless such person is
accompanied by an adult.
d) No greyhounds shall be exercised in any public park without consent.
4) That I agree to open my kennels for inspection and photographing at any reasonable time by an authorised officer of
GRSA.
5) That the training of all greyhounds in my care will be under my personal supervision.
6) That I will notify GRSA within 48hrs of any change (temporary or otherwise) in the address of my kennels or my
residence.
7) That I will at all times keep and maintain greyhounds domiciled on my premises and/or for which I am responsible in
good condition and provide such greyhounds with proper accommodation, kennelling, food and clothing in
accordance with the standard usually provided or supplied in connection with the training of greyhounds.
8) That I will undertake to notify GRSA in writing within 48hrs of any change in the answers given to questions or
details submitted in this Application that may effect the continuance of such registration.
9) Four (4) Passport photographs (32mm x 25mm) must accompany this application along with proof of identity.
SECTION F: TO BE READ BY AN APPLICANT SEEKING REGISTRATION AS A
14 TO 16 YR OLD ATTENDANT
In making an application for registration as an Attendant with GRSA, I acknowledge that any registration issued to me is
subject to the following conditions:
1. I have read and understand the conditions on the front page.
2. That I will notify GRSA forthwith of any change (temporary or otherwise) to my address.
3. That I will only be permitted to catch greyhounds.
4. That I will undertake to notify GRSA in writing within 48 hours of any significant change in the answers given to
questions or details submitted in this application.
5. I have completed and attached the appropriate questionnaire with this application.
6. Four (4) Passport photographs (32mm x 25mm) must accompany this application along with proof of identity.
CONSENT OF PARENT OR GUARDIAN
I, .................................................................................................................................. hereby consent to this application for
registration as an attendant.
......................................................................................................
(SIGNATURE OF PARENT OR GUARDIAN)
APPLICABLE TO OWNERS /ATTENDANTS AND TRAINERS ONLY
PROOF OF IDENTITY DECLARATION
(Must be completed by one of the following:- Police Officer, Bank Manager, Registered Medical Practitioner,
Officer of GRSA, Justice of the Peace.
PLEASE PRINT
I ..................................................................................................................................................................
Address: ........................................................................................ Postcode .............................................
Home Telephone ................................................... Work Telephone: ........................................................
................................................................................................ Date:
/
/
Signature
declare that I have known ...........................................................................................................................
Print full name of applicant
for ..................... year(s) and vouch for their identity.
I have endorsed the back of Two photographs
 Yes

No
(Please tick appropriate box)
APPLICABLE TO TRAINERS AND OWNER/TRAINERS ONLY
PLAN OF KENNELS
(If insufficient space attach separately)
OFFICE USE ONLY
State Particulars of Kennels
Number: _________________________________________________________________________________
Construction – Roof: _______________________________________________________________________
Construction – Walls: ______________________________________________________________________
Are Kennels padlocked? ____________________________________________________________________
Address where Kennels are located: ___________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
STATUTORY DECLARATION OF ACCURACY
I, .................................................................... of ..........................................................................................
The abovenamed Applicant do solemnly and sincerely declare that the information tendered in this Application is
correct and accurate and that I have read all the conditions appearing in this Application and acknowledge and agree to
abide by all such conditions. I also hereby authorise GRSA to check any details of information given in this statement,
i.e. criminal convictions, financial commitments, as GRSA in its absolute discretion deems necessary.
I make this solemn declaration consciously believing the same to be true, and by virtue of the provisions of the Oaths
Act, 1936.
Made and subscribed by the abovenamed and declared
This ______________________________________
Day of ____________________________________
At ________________________________________
Before me: _________________________________
Justice of the Peace
Commissioner for Taking Declarations or Affidavits
__________________________________
Signature of Declarant (Applicant)
CHECK LIST
For
Attendant, Owner/Attendant,
Owner/Trainer, Public Trainer,
14 to 16 Attendant
1.
Have you attempted to answer all of the questions.
2.
Is the correct money enclosed.
3.
Has Statutory Declaration been signed in the presence of a Justice of the Peace.
4.
Have you completed the taxation details.
□
□
□
□
If applicable,
5.
6.
7.
8.
9.
10.
□
Is Proof of ID completed by the appropriate person.
□
Is the appropriate questionnaire included.
□
Have you enclosed character references.
□
A copy of your National Police Record supplied (Applicable to Owner Trainer ONLY) □
Attached proof of employment or income. (Applicable to Public Trainer ONLY)
□
Have you enclosed four (4) passport photos.
_______________________________________________________________________
From time to time Greyhound Racing SA is contacted by various people interested and requiring
information about the Greyhound Racing Industry. However we cannot provide this information
without the consent of the individual under GRSA’s Privacy Policy. It would be appreciated if
you could complete the following question in relation to your NAME and PHONE NUMBER being
released.
Do you give permission for GRSA to release your name and phone number/s
with respect to industry related items?
YES
/
NO
(Please circle applicable)