Contact Information

Team Name(Required)

Team Captain(Required)

Phone Number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about us?(Required)

Second Representative Contact Name(Required)

Phone(Required)

Sport & Background

Select your chosen sport(Required)

Monday Mixed Beach Volleyball

Wednesday Mixed Beach Volleyball

Monday Ladies Netball

Have you played in the SJCRC sports competition before?(Required)

Yes

No

What was your previous teams name?(Required)

Player Registration

Player Information

Name of Player

Phone Number

Email

Photo Permission (Yes/No)

Player & Team Sign Off

Terms & Conditions(Required)

By ticking this box, I confirm that all players listed have agreed to the Terms & Conditions including photographic permission, conditions of payment and declaration.

PHOTOGRAPHIC PERMISSION
Occasionally YMCAWA staff may take photographs of the Centre and the participants taking part in the activities. I grant permission for
any image, photograph or film taken during program activities that may feature the enrolled adult/child to be used by YMCAWA of Perth
(Inc) for promotional uses. Please initial in column provided for permission.

CONDITIONS OF PAYMENT
1. The team registration fee must be paid before the first game is played.
2.A FORFEIT FINE OF $144.00 for Beach Volleyball & $174.00 for Netball will apply to all teams that are unable to or do not attend a
fixtured game. This fine must be paid within 14 days. If not paid within this time frame, the team can be removed from the
competition, at the Sports Managers discretion.
3.Games are not played on public holidays unless advised otherwise.
4.It is the responsibility of the team captain to obtain a copy of the center’s bylaws and ensure that all team members abide by them.
5.A fee of $165 will be charged to a team withdrawing from the competition at any time during the current season.

DECLARATION
I warrant that I have, on behalf of all members from time to time of the team, the authority to make this declaration and accordingly on
behalf of the team named on this form, I declare that we will abide by the Serpentine Jarrahdale Community Recreation Centre Bylaws,
participate in all matches programmed (including any time / day changes) for the duration of the season and undertake to honour any
fines allocated by the management. It is agreed that the YMCAWA of Perth will consent a rebate amount on standard team’s invoices
for scheduled playing fixtures and that this rebate will allow teams the capacity to engage the services of umpires. The YMCAWA will
coordinate the umpiring roster, however, will not be responsible for payment, or conduct of umpiring services, which remain the
responsibility of the teams or their authorized representatives.
I further, again being authorised by the team and on behalf of all members from time to time of the team, agree to fully indemnify the
Serpentine Jarrahdale Shire, the YMCAWA Perth (Inc) and all employees of the Serpentine Jarrahdale Community Recreation Centre,
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 Serpentine Jarrahdale Community Recreation Centre premises

Name of Team Representative(Required)

Signature(Required)

Date(Required)

Sports Team Nomination Form