SLC Adult Sports Nomination Form - City of Stirling

SENIOR SPORTS NOMINATION FORM
TEAM NAME:________________________________________________________
TEAM CONTACTS
The First Contact must be aged 18 years or older. Team contacts are responsible for all fees and communication .Please ensure
ALL sections of the form are completed in full.
First Contact
Name:_______________________________________________ D.O.B______ /______ /______
Address:________________________________________________________________________
_______________________________________________________________________________
Phone: (hm)____________________________ (mob)___________________________________
Email Address:___________________________________________________________________
Second Contact
Name:_______________________________________________ D.O.B______ /______ /______
Phone: (hm)__________________________ (mob)____________________________________
Email Address:__________________________________________________________________
Hamersley
Monday Mixed Netball
Tuesday Ladies Netball
Wednesday Indoor Soccer
Thursday Ladies Basketball*
COMPETITION (please circle)
Mirrabooka
(Herb Graham Recreation
Centre)
Monday Men’s Basketball
Monday Rebound Soccer
Tuesday Ladies Netball
Wednesday Men's Basketball
Wednesday Soccer (Futsal)*
Wednesday Ladies Basketball*
Scarborough
Monday Men’s Rebound Soccer
Monday AM Netball
Tuesday Basketball
Wednesday Mixed Netball
*Competitions will begin once enough nominations are received. Please complete the form if your team is interested
If there is a competition / sport you would like to play that is not listed above, please contact
(08) 9205 7601

What is your preferred Grade?
A B C
Competitions will only be split into grades if there are enough teams
PLAYER DETAILS
Name Phone Number Suburb Email Address
CONDITIONS OF REGISTRATION
HAVE THE MAJORITY OF THESE PLAYERS PARTICIPATED AS A TEAM BEFORE? YES NO
PLAYERS MAY BE ADDED TO YOUR FORM AFTER THE START OF THE SEASON.
PLAYERS ARE NOT PERMITTED TO BE REGISTERED OR PLAY REGULARLY FOR MORE THAN ONE TEAM PER NIGHT.
BREACHES OF THIS MAY RESULT IN LOSS OF COMPETITION POINTS OR REMOVAL FROM THE COMPETITION
IF ANY PLAYERS HAVE BEEN BANNED / SUSPENDED FROM PLAYING AT ANOTHER CITY OF STIRLING LEISURE FACILITY, YOU
MUST DISCLOSE THIS AT TIME OF ENTERING COMPETITION. FAILURE TO DO SO MAY RESULT IN LOSS OF COMPETITION POINTS,
OR THE WITHDRAWAL OF YOUR TEAM FROM THE COMPETION
CONDITIONS OF PARTICIPATION
THE TEAM REGISTRATION FEE MUST BE PAID BEFORE THE START OF THE THIRD WEEK OF THE COMPETITION
TEAMS ARE COMMITTED FOR AN ENTIRE SEASON. WITHDRAWAL WILL INCUR A $100 WITHDRAWAL FEE.
FORFEIT FINES APPLY. PLEASE REFER TO BY-LAWS FOR DETAILS REGARDING FORFEIT FINES.
ABUSIVE AND THREATENING BEHAVIOUR WILL NOT BE TOLERATED AT STIRLING LEISURE CENTRES AND ANY
INAPPROPRIATE, THREATENING OR ABUSIVE BEHAVIOUR WILL BE DEALT WITH BY MANAGEMENT.
PLEASE REFER TO THE BY LAWS BEFORE SIGNING THE DECLARATION BELOW.
DECLARATION
ON BEHALF OF THE TEAM NAMED ON THIS FORM, I DECLARE THAT WE WILL PARTICIPATE IN ALL MATCHES PROGRAMMED FOR THE DURATION OF
THE SEASON (INCLUDING FINALS) AND TO HONOUR ALL FORFEIT FINES AND SUSPENSIONS THAT MAY BE IMPOSED ON THIS TEAM BY
MANAGEMENT. I DECLARE ON BEHALF OF THE TEAM THAT WE UNDERSTAND THAT TAKING PART IN ANY SPORTING GAME COMES WITH THE
POSSIBLE RISK OF INJURY AND THAT THE CITY OF STIRLING IS NOT LIABLE FOR ANY COSTS INCURRED BY PLAYERS AS A RESULT OF AN INJURY
SUFFERED DURING THE COURSE OF PLAY. I FURTHER, BEING AUTHORISED BY THE TEAM, AGREE TO FULLY INDEMNIFY THE CITY OF STIRLING AND
ALL EMPLOYEES AGAINST ANY CLAIMS HOWEVER ARISING WHICH MAY BE MADE AGAINST THEM AS A RESULT OF OUR TEAMS, USE OR
PARTICIPATION IN OR PRESENCE WITHIN THE RECREATION CENTRE PREMISES. TEAMS AND INDIVIDUALS ARE RESPONSIBLE FOR ARRANGING
THEIR OWN PERSONAL ACCIDENT OR INJURY INSURANCE. MY TEAM AND I ARE
ALSO AWARE OF THE BYLAWS THAT THE CITY OF STIRLING HAS IN PLACE
Signed:_______________________________________
Date:___________/__________/__________________