Courtside Multisports

		35 Catalano Road Canning Vale Western Australia 6155 Phone: 08 9455 4322

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Junior Sport Online Nomination Form

This Nomination Form can only be accepted with payment of your registration ($60).
All sections must be completed in full.

Enter your details (*denotes required fields)

Section 1: Contact Details - Team Nomination

Team Name	*

Team Manager
Team Manager Name	*
Address	*
Suburb	*
Postcode	*
Email Address	*
Home Phone	*
Work Phone	*
Mobile	*
Fax

Team Coach (if appointed)
Team Coach Name
Address
Suburb
Postcode
Home Phone
Work Phone
Mobile
Fax

Section 2: Player Registration - Team Nomination

Player 1
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 2
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 3
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 4
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 5
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 6
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 7
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 8
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 9
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone


Player 10
Name
School		Date of Birth
Address
Suburb		Postcode
Home Phone

Section 3: Contact Details - Individual Nomination

Child's Name
School
Date of Birth

Parent/Guardian's Details
Parent/Guardian's Name:
Address
Suburb
Postcode
Home Phone
Work Phone
Mobile
Fax

Section 4: Survey

How did you hear of Courtside Multisports?

Other (please specify):

Section 5: Sport Nominating For

Please select one

Indoor Cricket

Netball

Floorball

Soccer

Section 6: Age Group Nominating For

Please select one

8s & Under

10s & Under

12s & Under

14s & Under

16s & Under

18s & Under

Section 7: Parent/Guardian Assistance

It is necessary for Parents or Guardians to assist with coaching, umpiring, or scoring on occasion. We are grateful for any Parents willing to assist - (please complete your details below and tick where appropriate)

Name of Parent/Guardian	Home Phone	Coaching	Umpiring	Scoring






Teams are responsible for umpires' fees

Section 8: Declaration

(please read the ‘Information for Nominating Teams’ sheet prior to signing this declaration)

I warrant and declare that I have the authority on behalf of all members of the team to make this declaration. Accordingly, on behalf of the team named on this form, I declare that the team will participate in all matches programmed for the duration of the season (including final matches) and hereby undertake to be personally liable to pay any fines that may be imposed as a result of this team withdrawing or causing a match to be forfeited or any other fines imposed by the Sports Co-ordinator or Courtside (see Information for Nominating Teams).

I, further being again authorised by all of the members of the team, acknowledge that the members of the team agree jointly and severally to fully indemnify the owners of Courtside Multisports and its officers, employees, representatives and contractors against any and all claims however arising which may be made against them as a result of our teams use of the services, facilities, equipment or apparatus at Courtside Multisports, our participation in any events, games, competition at Courtside Multisports or our presence at Courtside Multisports or its immediate surrounds.

I hereby declare that I have read the above declaration and agree with it.