Torrens Valley Soccer Club Inc
PO Box 388 Birdwood SA 5234  www.torrensvalleysoccerclub.com
Registration Form 2013 - Senior Women
Please note: This form is to be filled out by each individual player. A player is not registered with the club, insured or able to play in
official matches for the club until registration fees are paid in full. Junior players will also need to complete this form and pay the
relevant Women’s team fees in addition to their junior registration and fees.
Under direction from Football Federation South Australia, all players will also need to complete online registration at
www.myfootballclub.com.au. Players are not permitted to play until this process has been completed in full. The online registration
deadline is March 22 to be able to play in the first round on April 7 and then 48 hours prior to each match thereafter.
FFA Registration Number
(You’ll get a number once you register online)
Full Name
Residential Address
Inc Post Code
Postal Address
Inc Post Code (If different than above)
Date of Birth (dd/mm/yyyy)
Telephone
Mobile Phone
Email
(please write clearly)
Did you play for Torrens Valley
Soccer Club in 2012?
YES / NO
(please circle)
If no, when was the last time you played
for Torrens Valley Soccer Club?
...................... / Never
(enter year or circle)
Your previous club
Year last played with this club
(Registered juniors to contact registrar for fee info)
$210.00
+$30.00  Shorts and socks
(*Full amount due prior to first match) +$35.00  Polo shirt (optional)
Amount Paid on Registration
$
......................
(minimum $150*)
Date:
......................
FEE DUE:
Subsequent payments
$...................... Date: ...................... Init: ............
$...................... Date: ...................... Init: ............
Name: ...............................................
Committee Member Receipt
Signature
...............................................
Photographs and Email Address
Photographs and/or video may be taken of you while playing in matches or during other
activities associated with the Club. Such media may be used (but not limited to) in local
media publications and on the TVSC website or social media pages. Signing this form
constitutes your acceptance of the use of your image in such media.
Date:
...............................................
Your email address will be added to a database of current and existing TVSC members
and you may receive club newsletters or information about upcoming club events from
time to time. You are also encouraged to join the TVSC Facebook page.
Form not valid unless signed by a Committee Member
Please make sure that you receive a signed receipt for any monies paid by you to a Club Official
DISCIPLINE & FINES
Individual players will be required to reimburse the Club for the cost of certain fines
levied on the player. In particular this includes – but is not limited to – fines imposed by
the FFSA accrued during the course of matches played for the Club.
Loss-of or Damage-to club uniform, equipment or facilities (excluding “normal match play
or use”) will result in the full cost of the item or repairs being charged to the player.
Yellow/Red Cards
The Club receives a monetary fine and the player is suspended for one (1) match when
they accrue five (5) yellow cards (then at 8,11,14 and 17 card intervals). The Club receives
a monetary fine and the player is suspended for at least one (1) match each time a player
receives a red card.
Any card resulting in a sending off for fighting OR verbal abuse, the player will be liable to
reimburse the Club for fines received. Additional fines and/or club penalties may be
imposed at the discretion of the Head Coach and/or Committee.
Suspensions
A PLAYER WILL NOT BE ELIGIBLE TO PLAY FOR THE CLUB UNTIL ALL OUTSTANDING FINES
FOR THAT PLAYER HAVE BEEN PAID TO THE CLUB.
Players must serve their suspension as linesman for one of the club's senior or
competitive junior teams and the ban will remain in place until that duty has been
served.
Attendance
At the discretion of the head coach:
Any 'no show' for a game will receive a one (1) match ban.
Failure to provide adequate notice that a player isn't available will result in a ban at the
head coach’s discretion based upon circumstances. Adequate notice means by 9pm on
the day before a game.
It is the responsibility of each individual player to notify the head coach if they are
unavailable for selection.
MEDICAL INFORMATION
Any health information given will not prevent participation in any club activity unless
further medical advice warrants exclusion. The information requested will be considered
confidential by the club and will be treated accordingly. The information is sought in
order to protect and assist the player so that this activity may be a safe and enjoyable
experience.
Emergency Contact
(Someone we can contact in the case of an
emergency)
Name:
Phone Number:
Family Doctor/Clinic:
In the event of an emergency, do you
give permission to receive a blood
transfusion by a qualified medical
practitioner?
YES / NO
(please circle)
Have you had a complete course of
tetanus toxoid?
YES / NO
(please circle)
The club reserves the right to use the ambulance service, should the need arise. Should the need arise the player will be
solely responsible for costs incurred.
Does the player have any medical
condition or health problem of which
the club should be aware of?
(e.g. Allergies, asthma, epilepsy)?
Accidents or injuries to players or
members
YES / NO
(please circle)
Provide details and how it should be treated if problem arises:
The Torrens Valley Soccer Club, its officers or players or any members, do not
accept responsibility for injuries sustained whilst playing, training or at any other
function arranged by the club.
Declaration: I have read and understood all parts of this form and as part of my membership with the Club, agree to abide
by all sections. I understand that it is my responsibility to register on the myfootballclub website prior to the deadline and
pay relevant fees to the club prior to my first match. I agree to abide by all terms related to my FFA/FFSA Registration.
The information contained in this form is, to the best of my knowledge, true and accurate.
Signed (by Parent / Guardian if Under 18):
Print Name: