mixed JUNIORfutsal competition

Team nomination form

TEAM NAME/ TWO NOMINATED CONTACTS
Team name:
Contact name 1: / Contact name 2:
Suburb: / Suburb:
Postcode: / Postcode:
Telephone (H): / Telephone (H):
Mobile: / Mobile:
Email: / Email:
DATES& DETAILS
MONDAY13thFebruary 2017 from 3pm,
8 week comp
Each game will be 15 minute halves with a 5-minute half time.
Division A: 12 – 14 years
Division B: 11 & under
PLAYER DETAILS
NAME / CONTACT NUMBER / EMAIL
ADDITIONAL PLAYERS
Does your team require additional players? Yes No If YES, how many? _____
UNIFORM DETAILS
Shirt / Uniform colour
INFORMATION, TERMS AND CONDITIONS
  • Teams must be comprised of players suitable to the 2 divisions.
  • All nomination forms and fees must be complete and paid in FULL by the datelisted in the FEES AND DATES section below, before a team can participate in the competition.
  • New players are welcome throughout the season as long as they are registered before their first game.
  • All game fees must be paid before the commencement of a game.
  • Causing a match to forfeit will incur the loss of the team nomination fee and therefore the team will not be able to play until fee is paid.
  • Team members are responsible for reading the Rules and Regulations document specific to their chosen sport. This document will be emailed to team contacts and made available at the Karratha Leisureplex
  • Fixtures will be emailed to contacts and displayed, along with results and ladders at the Karratha Leisureplex and on the website. Results and ladders will be available on the KLP Facebook page.
  • Teams are expected to play under the general principles of fair play and good sportsmanship. Failure to do so may result in penalties to a player and/or team.
  • Any injuries sustained during a game must be reported to centre management and a Visitors Accident Form must be completed.
  • Any issues involving an umpire decision can be addressed during a break or at the completion of a game by the team contact/captain only or by contacting Karratha Leisureplex Management.
  • The Karratha Leisureplex holds the right to suspend or disqualify a team and/or player from the competition if their behaviour is deemed unacceptable by management.

FEES AND DATES
NOMINATE BY:Monday, 6th February
NOMINATION FEE: $80(This is the equivalent to two (2) game fees.To be paid just before your first game. This will mean the last two games will be paid for. This is a non-refundable amount should the team withdraw from the competition)
DAY AND TIME:Monday 3.00pm – 5.00pm. The draw will be distributed on Thursday, 9thFebruary.
PRICE PER GAME: $40 per team
DECLARATION *Please ensure you have read and completed the entire form before signing the declaration*
In signing this form, we, on behalf of all members, have the authority to declare that
(team name) ______understands that:
  • We have read and shared the INFORMATION, TERMS AND CONDITIONS with all members.
  • We are aware that personal injuries may arise directly or indirectly from sport and participation is at own risk.
  • We take full responsibility for personal property and may not hold Karratha Leisureplex responsible for any lost or stolen items.
  • Photographs of team members may be taken and used by the Karratha Leisureplex for promotional purposes.
  • We understand and accept the rules of competition and any consequences that may be incurred for failure to comply with these rules (as outlined in the Leisureplex Rules and Regulations document)
Contact 1 Signature______Date ______
Print ______Date ______
Contact 2 Signature______Date ______
Print ______Date ______
*Note: Having completed this declaration it is your responsibility to ensure that you have a copy of the Rules and Regulations of your nominated sport and that ALL players are aware of them.

Return completed form to the Programs Department:

Post: PO Box 219 Karratha WA 6714

In person: Dampier Highway opposite Broadhurst Road

Email:

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