Courtside Multisports

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

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Senior Sport Online Nomination Form

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

Section 1: Team Name and Contact Details

Team Name	*

Captain Deatils
Captain Name	*
Address	*
Suburb	*
Postcode	*
Email Address	*
Home Phone	*
Work Phone	*
Mobile	*
Fax

Vice Captain Details
Vice Captain Name
Address
Suburb
Postcode
Email Address
Home Phone
Work Phone
Mobile
Fax

Section 2: Sport and Grade You Seek To Nominate For

Please select one:

Sport

Grade

Indoor Cricket

Mens

Ladies

Mixed

Netball

Mens

Ladies

Mixed

Basketball

Mens

Ladies

Mixed

Soccer

Mens

Ladies

Mixed

Softball

Mens

Ladies

Mixed

Beach Volleyball

Mens

Ladies

Mixed

Section 3: Day and Grade Preferred

First Choice

Day/Evening

Day

Evening

Day of the Week

Second Choice

Day/Evening

Day

Evening

Day of the Week

Section 4: Survey

How did you hear of Courtside Multisports?

Other (please specify):

Section 5: Team History

Have the majority of players participated as part of this team before?

Yes

If 'Yes' what was the team name?

Sport played

Grade Played

Night/Day Played

Centre/Venue

Section 6: Player Registration (other than captain and vice captain)

Player 1
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 2
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 3
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 4
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 5
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 6
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 7
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 8
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 9
Name
Address
Suburb		Postcode
Home Phone		Work Phone


Player 10
Name
Address
Suburb		Postcode
Home Phone		Work Phone

Teams are responsible for umpires' fees

Section 7: 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.