2016 PLAYER REGISTRATION/TRANSFER FORM
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 enter 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.
PLAYER’S DETAILS
Legal First Name:
Preferred Name:
Family Name:
Gender (Please tick)
Date of Birth:
Male
/
Place of Birth:
Female
(i.e. Dandenong, Australia)
Are from Aboriginal/Torres Strait Islander origin?
Yes
No
Have you played Competition Football before?
Yes
No
If YES, Last club played with:
League/Association:
Have you ever participated in any Auskick program before?
Yes
No
If YES, Which Centre?
What School do you attend?
CONTACT INFORMATION
Street Address:
Suburb:
Phone (home):
State:
Postcode:
Phone (work):
Phone (mobile):
Email Address:
Parent/Guardian 1
First Name:
Phone (home):
Family Name:
Phone (work):
Phone (mobile):
Email Address:
Place of Birth:
(i.e. Dandenong, Australia)
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2016 PLAYER REGISTRATION/TRANSFER FORM
Parent/Guardian 2
First Name:
Phone (home):
Family Name:
Phone (work):
Phone (mobile):
Email Address:
Place of Birth:
(i.e. Dandenong, Australia)
IN CASE OF EMERGENCY
Emergency Contact 1:
Name:
Phone (home):
Relationship to Player:
Phone (work):
Phone (mobile):
Emergency Contact 2:
Name:
Phone (home):
Relationship to Player:
Phone (work):
Phone (mobile):
MEDICAL INFORMATION
Do you have any medical conditions?
Yes
No
If YES, please specify
Any allergies/medications?
Yes
No
If YES, please specify
Do you consent to your child receiving emergency medical or hospital treatment?
Medicare Number
Do you have ambulance cover?
Yes
Do you have Private Health Insurance?
No
Yes
Member Number:
No
If YES, please provide following information:
Health Fund:
Member Number:
Doctor/Practice Name:
Phone:
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Yes
No
2016 PLAYER REGISTRATION/TRANSFER FORM
VOLUNTEER & WORKING WITH CHILDREN (WWC) CHECK INFORMATION
Parkmore Junior Football Club has always been fortunate in having very hardworking and dedicated
members, players and families over the past 40 years.
Volunteers are an integral part of our Club. They help to ensure the smooth running of a game, from coach
to goal umpire, team manager to committee members, time keeper to running the canteen. Without an
army of volunteers, our club wouldn't be what it is today.
All volunteers are required to obtain/hold a current Working With Children (WWC) Check. The WWC
Check helps protect children from physical and sexual harm. It does this by screening people’s criminal
records and professional conduct and preventing those who pose an unjustifiable risk to children from
working with or caring for them.
To apply for a WWC check, go to the Working With Children website and click on "Apply for a Check".
Then print out the summary of your details along with your receipt and lodge it at a participating Australia
Post retail outlet, along with 100 points of identification, a passport-size photo. Volunteer WWC Checks
are FREE.
It would be greatly appreciated if you could please let us know if you are able & willing to assist the Club
with any of the following:
Game day setup
Yes
No
Goal Umpire Yes
No
Trainer/First Aid
Yes
No
Timekeeper Yes
No
Umpire Escort
Yes
No
Runner Yes
No
Water Carrier
Yes
No
Cook on the BBQ Yes
No
Help in the Canteen
Yes
No
If you have a current WWC Check, kindly fill in the following details:
Date WWC Check Obtained
/
/
/
/
WWC Check Number
WWC Expiry Date
If you have any special attributes, knowledge or services and are willing to donate your time, we would love
to hear from you. Please don't hesitate to contact either Michael Palma on 0407 566 155 or Michael
Sheahan on 0415 522 640 or your child's Coach and/or Team Manager.
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2016 PLAYER REGISTRATION/TRANSFER FORM
LEAGUE/CLUB COMMUNICATIONS
League/Club Information:
Yes, I do consent
No, I don't consent
League/Club Sponsor Information:
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 03 9701 1672.
Members' 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 players 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:
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2016 PLAYER REGISTRATION/TRANSFER FORM
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;
(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.
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2016 PLAYER REGISTRATION/TRANSFER FORM
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.
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