Judo Western Australia (Inc.) – 2015-2016 Club Affiliation Form

Valid to 30/06/2016

In order to affiliate your club please fill in all details applicable on both sides of the form and forward the form and required registration fee (Separately invoiced) to: Judo WA (Inc.) Membership Officer,
30 Canterbury Circle, Currambine WA 6028, or email .

Club Details:

Name of Club:
Correspondence Address:
Training Venue Address:

(If training in more than one location, please provide details on separate sheet (not included))

Club Training Details:

Juniors: / Day(s) of Week
Time
Seniors: / Day(s) of Week
Time
Other Training: / Day(s) of Week
Time

Club Officials’ Details:

Position: / President / Manager / (Please select one)
Name:
Address
Phone / Mobile:
Fax: / Email:
Position: / Secretary / Assistant Manager / (Please select one)
Name:
Address
Phone / Mobile:
Fax: / Email:
Position: / Treasurer
Name:
Address
Phone / Mobile:
Fax: / Email:

We, the undersigned persons, who are seeking affiliation of: (Insert your club's name)

______

Hereby apply for affiliation of the said Club to Judo WA (Inc.). In so doing and in consideration for affiliation being accepted we acknowledge and agree that:

  1. Judo WA (Inc.) for the purposes of this declaration means & includes Judo Western Australia (Inc.), its members (including Clubs), Branches & their respective directors, officers, members, servants or agents.
  2. This document cannot be amended. If I amend it my application will be null & void. It cannot be accepted by Judo WA (Inc.)
  3. Insurance is not provided to the individual members of the Club or to the Club itself by its affiliation to Judo WA (Inc.). Individual members and/or Clubs can seek and obtain their own insurance cover.
  4. The Judo WA (Inc.) Constitution is a contract between the Club and Judo WA (Inc.). The Club will be bound by it & any By-laws made under it. It is necessary & reasonable for promoting Judo WA (Inc.), the Club and Judo as a community service. Further the Club understands that it shall be bound by all rules made by any subsidiary body to which Judo WA (Inc.) is affiliated.
  5. Exclusion of Liability: Except where provided or required by law & such cannot be excluded, the Club agrees that it is a term of its affiliation (if accepted) that Judo WA (Inc.) is absolved from all liability however arising from injury or damage however caused (whether fatal or otherwise) arising out of the Club affiliation &/or participation in any Judo WA (Inc.) activity.
  6. Release & Indemnity: In consideration of Judo WA (Inc.) accepting the Club application for affiliation, the Club:
  7. Releases & forever discharges Judo WA (Inc.) from all claims that the Club may have or may have had but for this release arising from or in connection with the Club affiliation &/or participation in any Judo WA (Inc.) activity, &
  8. Indemnifies & holds harmless Judo WA (Inc.) to the extend permitted by law in respect of any claim by any club or person including but not only another member / affiliate of Judo WA (Inc.) arising as a result of or in connection with the club affiliation &/or participation in any Judo WA (Inc.) activity.

In the clause 5 ‘claims’ means & includes any action, suit, proceeding, claim, demand, damage, penalty, cost or expense however arising but does not include a claim in respect of any action, suit, etc made by any person or club entitled to make a claim under a relevant Judo WA (Inc.) insurance policy or under the Judo WA (Inc.) Constitution or any By-laws.

  1. The club has provided the information on both sides of this form and it is signed as necessary. The club warrants that all the information provided is true and correct.
  2. Judo WA (Inc.) has a privacy policy and the club acknowledges that the informationprovided is necessaryfor the objects of Judo WA (Inc.) The club acknowledges and agrees that the information will be disclosed to JFA (Inc.) and otherwise will only be used for the objects of Judo WA (Inc.) and to provide the club with affiliation services. The club understands that it can access this information from Judo WA (Inc.). If the information is not provided the club understands that its affiliation application may be rejected.
  3. The club understands, acknowledges and agrees to the above declaration including the exclusion of liability, release & indemnity. The club acknowledges that if the application for affiliation is successful the club will be entitled to all the benefits, advantages, privileges & services of Judo WA (Inc.) affiliation.

Position: / CLUB PRESIDENT/MANAGER / Signature:
Print name: / Date:
Position: / CLUB SECRETARY/ASS. MANAGER / Signature:
Print name: / Date:

Clubs affiliated with Judo Western Australia (Inc.) must ensure that all of their officials and in particular those who actively interact with children meet all the minimum criteria associated with that position. It is a legal requirement that clubs adhere to all Working With Children Check (WWC) requirements.

Please submit copies of WWC cards and current 1st Aid certification for each coach / official in your club with this application. Coaching credentials will be collected separately.

Coach / Official Registrations: (Please make additional copies of this page if you have more than 3 coaches / officials)

Position: / Head Coach
Name:
Address:
Phone: / Mobile:
Fax: / Email:
WWC Card Number / Valid until: / (Attach copy)
1st Aid Certification date: / Valid until: / (Attach copy)
Judo WA membership No: / Clubs must ensure that all coaches are currently registered members of Judo WA
Current Judo WA grade: / Minimum grade for any coach is a JFA recognised 2nd Kyu (Blue belt). Judo WA strongly recommends the minimum grade to be JFA recognised 1st Dan (Black belt) or above.
Position:
Name:
Address:
Phone: / Mobile:
Fax: / Email:
WWC Card Number / Valid until: / (Attach copy)
1st Aid Certification date: / Valid until: / (Attach copy)
Judo WA membership No: / Clubs must ensure that all coaches are currently registered members of Judo WA
Current Judo WA grade: / Minimum grade for any coach is a JFA recognised 2nd Kyu (Blue belt). Judo WA strongly recommends the minimum grade to be JFA recognised 1st Dan (Black belt) or above.
Position:
Name:
Address:
Phone: / Mobile:
Fax: / Email:
WWC Card Number / Valid until: / (Attach copy)
1st Aid Certification date: / Valid until: / (Attach copy)
Judo WA membership No: / Clubs must ensure that all coaches are currently registered members of Judo WA
Current Judo WA grade: / Minimum grade for any coach is a JFA recognised 2nd Kyu (Blue belt). Judo WA strongly recommends the minimum grade to be JFA recognised 1st Dan (Black belt) or above.