PLAYER REGISTRATION/TRANSFER FORM
Season:________
All new players, players being transferred from Auskick or players being transferred from another club are to complete this league
registration/transfer form before being transferred or registered as a member with the SEJ for the current season.
1. ALL PLAYERS & PARENTS are required to READ the conditions of registration and complete and sign the form below.
2. Club registrars/secretaries are required to eneter ALL new registrations and transfer requests through the online footyweb database.
3. Clubs are to hold onto all registrations/transfer forms and copies of proof of age documentation. Clubs will need to ensure that this
documentation can be produced if requested by the league.
Personal Details
First name:
Family name:
Gender: Female
Date of Birth:
/
/
Male
In which Country was player born:
Australia
Other
(Please Specify)
Address and Contact Information
Street Address:
State:
Suburb:
Phone (Home):
Postal Code:
Phone (Work):
Phone (Mob):
Email:
Player Information
Have you played competition football before?
If YES, Last Club Played with:
Yes
No
League/Association:
No
Have you ever participated in any Auskick program before? Yes
If YES, Which Centre?
Medical Information
Any medical conditions: Yes
Any Allergies: Yes
No
No
Do you consent to your child receiving emergency medical or hospital treatment?
Do you have ambulance cover?
Yes
No
Do you have Private Health Insurance?
Yes
No
Doctors Name:
Yes
No
Health Fund:
Contact:
Parent/Guardian Information
Parent/Guardian Firstname:
Parent/Guardian Surname:
Parent/Guardian Phone:
Parent/Guardian Email:
In which Country was Parent/Guardian born: Australia
Parent/Guardian 2 Firstname:
Other
Please Specify
Parent/Guardian 2 Surname:
Parent/Guardian 2 Phone:
In which Country was Parent/Guardian 2 born: Australia
Parent/Guardian 2 Email:
Other
Please Specify
Page 1/2
Emergency Contact Information
Emergency Contact Name:
Emergency Contact Number:
Emergency Contact Relationship:
Emergency Contact 2 Name:
Emergency Contact 2 Number:
Contact 2 Relationship:
League/Club Communications
League/Club Info: Yes, I do consent
No, I don’t consent
League/Club Sponsor Info: Yes, I do consent
No, I don’t consent
I agree to receive communications from the association and its associated partners that are related to my
participation in the association. Communications include newsletters, emails and SMS which may contain
a commercial purpose (that funds the cost of transmitting the message) and may not include an ability to
opt-out, as such communication enables the association to operate effectively. I can stop receiving the
messages by contacting South East Juniors at [email protected] or 9701 1672.
Member's Declaration:
This is a legal document - by acknowledging you will be bound by the terms and conditions.
I hereby seek permission to register with the Club, subject to due compliance with the
requirements of the League with which the Club is affiliated.
I hereby acknowledge that I have read the conditions of registration and the Privacy Policy
and agree that I am bound by those conditions.
I DECLARE that the above particulars are, to the best of my knowledge, and belief, true and correct.
I have read and agree to the Terms and Conditions :
Name of Parent:
Signature of Parent:
Date:
/
/
Date:
/
/
Name of Player:
Signature of Player:
- Office Use Only Proof of Age cited
(new player's cannot be registered with SEJ until a copy of the proof of age
documentation has been secured by the club)
Club Official Name: (please print)
Club:
Position held at club:
Signature:
Date:
/
/
Page 2/2
CONDITIONS OF REGISTRATION
1. Player / Parents and Guardian Bound by Rules, Regulations and Policies of the Club, the League and
AFL Victoria.
By acknowledging this Registration Form, the Player/Parents/ and Guardian;
(a) agrees that he or she will comply with and observe the Rules, Regulations and Policies of the Club, the
League, AFL Victoria and the State Government as they are presently constituted and as amended from
time to time;
(b) acknowledges that he or she may inspect copies of the Rules, Regulations and Policies of the Club,
the League or AFL Victoria during normal business hours at the respective offices of those organisations;
(c) acknowledges that his or her failure to adhere to the Rules, Regulations and Policies of either of the
Club, the League, AFL Victoria or of the State Government may result in him or her being de-registered
and/or other sanctions.
(d) Players under the age of 18 as a condition of your registration with the club/league will be asked to
provide proof of age.
2. Assumption of Risk
By acknowledging this Registration Form, the Player acknowledges and agrees that:(a) Australian Football is a vigorous body contact sport in which physical injury is likely to occur from
time to time;
(b) he or she is none the less desirous of playing Australian Football for the Club; and
(c) he or she takes upon himself the risk (both physical and legal) of injury arising in the course of training
for and participating in the game of Australian Football.
3. Registration of Players Under 18 Years of Age
Where the Player is under 18 years of age, by acknowledging this Registration Form the Parent or
Guardian of the Player:(a) hereby acknowledges that he or she has read and explained the contents of this Registration Form
(including Conditions 1 and 2 above) to the Player;
Page 1/2
(b) declares that the statements made in the Registration Form are to the best of his or her knowledge
and belief , true and correct;
and
(c) acknowledges that he or she has been informed of and/ or understands the potential dangers and
risks of the Player participating in a contact sport with older participants who may be larger and stronger
and that he or she has explained the potential dangers to the Player. The Parent/Guardian acknowledges
and agrees with the Club, the League and AFL Victoria, that the Parent/Guardian and the Player accept
the risk of the Player sustaining injury from playing Australian Football for the Club and forever releases,
indemnifies and saves harmless, the Club, the League, AFL Victoria, their respective servants, agents,
independent contractors and voluntary workers carrying out honorary or unpaid duties and each and
every person participating or otherwise engaged in Australian Football matches (including training
sessions) conducted by or under the auspices of the League or AFL Victoria, from all actions,
proceedings, demands, suits, claims, costs and expenses and other liabilities of whatsoever
nature directly or indirectly arising from any injury or impairment suffered as a result of the Players
participation.
4. Privacy Policy
The primary purpose South East Juniors obtaining the information in this form is in relation to your
application for your Player Registration. South East Juniors may also use your information for a purpose
that is associated with its Player Registrations Program and other purposes agreed by you. South East
Juniors will take all reasonable steps to protect your personal information from misuse or unauthorized
disclosure.
Full Privacy policy available at www.southeastjuniors.com.au
National Risk Protection Program
South East Juniors is part of the AFL National Risk Protection Program which provides a level of cover for
all affiliate clubs for;
Public Liability
Asset Protect
Personal Accident
Personal Injury
As a benefit of your affiliation with South East Juniors all clubs will be covered at a Silver level of cover
for personal accident insurance.
Silver Cover Includes:
-
75% reimbursement
$2500 maximum per claim
$75 excess per claim
$30,000 Capitol Benefit U/18
Optional Upgrade
Clubs may choose to upgrade their level of cover to Gold or Platinum Cover. Please contact your club
to determine which level of cover they have.
Page 2/2