Application Form & Agreement - 2017/18 Summer Football Season

Application Form & Agreement - 2017/18 Summer Football Season
1. Application Process

The Application Process to seek Football NSW endorsement of Summer Football Competitions comprises;
- Competition Information; and
- Terms and Conditions
Both of these processes are combined in this document.

Prospective Summer Football Competition Administrators are required to submit this document having answered all questions and executed where required.

Upon approval, Football NSW will issue a letter of endorsement to the Competition Administrator.

2. Submission

Each Applicant is required to complete this application process:

This form must be completed by an authorised person of the Applicant.

By submitting the form, the Applicant will be deemed to have reviewed, acknowledged and agreed to the terms and conditions set out in the form without reservation or variation.

Should you require any assistance in completing this form please contact the following Football NSW employee:

Matt Rippon

Email: mattr@footballnsw.com.au

Telephone: (02) 8814 4454

Lauren Moore

Email: laurenm@footballnsw.com.au

Telephone: (02) 8814 4431

Application Information
Name of Applicant (i.e legal entity name)*
Designation of Applicant*
ABN of Applicant*
Phone Number:*
In what manner is the application provided*
Note: All Applicants must be a registered entity i.e. a body corporate registered under the Corporations Act 2001 or an incorporated association registered under the Associations Incorporation Act 2009 (NSW).
Applicant Postal Address (please provide street address also if using a PO Box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Note: If you are selecting a resource package that conatins goals please provide a valid street address for them to be posted to.
Applicant Website*
Contact Person of Applicant *

First NameLast Name
Contact Person Phone Number*
Contact Person Email Address*
Grassroots Clubs are required to seek support of the Football Association to conduct Summer Football Competitions.

Please complete the following table should the applicant be a Grassroots Football Club:
Football Association in which you are geographically located*
Date at which you sought Football Association Support*

DayMonthYear
Football Association support provided by (insert contact name)*

First NameLast Name
Football Association support provided in writing on (insert date)*

DayMonthYear
ALDI MiniRoos Kick-Off

The ALDI MiniRoos Kick-Off program is a great way to approach players for the lead up to the 2018 winter football season. A fun, safe sport taught for children aged between 4 and 9. These weekly 45 minute sessions build skills through games and simple drills delivered in an engaging and inclusive environment.

What do you receive?

Each registered participant will receive a ALDI MiniRoos kick-off participations pack.
Each registered program will receive a ALDI MiniRoos Kick-Off delivery kit.
ALDI MiniRoos 4-6 & 7-9s Program session guides for coaches.

Are you interested in running an ALDI MiniRoos KickOff Program during your Summer Football program

http://www.miniroos.com.au/kick-off/
As Host Club of a Summer Football competition are you also interested in operating a MiniRoos Kick Off program from the site?*

Competition Information
Please indicate the Gender and Age Grades you propose to conduct (click save to add multiple lines)*
Venue Name*
Venue Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you have access to a canteen?
Do you have access to a medical facilities (i.e. medical kit, medical room etc.)?
Competition Period Commences*

DayMonthYear
Competitions Period Concludes*

DayMonthYear
What day(s) of the week does your competition run?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Please indicate the format in which your competition will be conducted i.e. 5v5, 6v6, 7v7 (click save to add multiple lines) Note: All U6 and U7 competitions must be run in a 4v4 format as per MiniRoos guidelines.*
Are you interested in nominating a Mens Summer Football Champions of Champions team?*
Are you interested in nominating a Womens Summer Football Champions of Champions team?*
Please select the body through which you intend to acquire referee services*
Afiliated Summer Football competitions are provided with resources to assist delivery of professional playing environments to their membership.

These resources are provided in either 'Summer Football in a Bag' Equipment Voucher from The Football Corner or referee subsidy.
Please choose one of the following options, regarding the resource you would prefer:*
Competition Regulations*
Please upload a copy of the competition regulations

Upload a File

Cancelof

Acknowledgement
I,*

First NameLast Name
in my capacity as (insert title)*
of (Applicant Association/Branch/Club)*
acknowledge and agree to the below Terms and Conditions:
If the terms and conditions do not load correctly please click HERE.
I have read and agreed to the above terms and conditions:*

Yes - I have read and agreed to the above terms and conditions:
I also acknowledge and agree to the following:
1. I am a person who is authorised to sign this application form on behalf of the Administrator;
2. the Administrator agrees to comply with the requirements and obligations set out in this application form including the terms and conditions;
3. on behalf of the Administrator, I have read and understood the application form in relation to the 2015/2016 Summer Football structure; and
4. on behalf of the Administrator, I have completed this application form to the best of my knowledge and ability and the contents of my submission are true and correct.
Signature (please sign below)*
Should be Empty:

Application Form & Agreement - 2017/18 Summer Football Season

Application Information

Competition Information

Acknowledgement