Volleyball SA Supplier Form

Volleyball SA Supplier Form
Personal Information
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Email*
example@example.com
Working With Children Check

All Volleyball SA suppliers who are aged 14 or older must have a current Working With Children Check before commencing work. If you don't have a current Working With Children Check, you can apply for one here.
Are you already 14 years old OR older OR turning 14 within the next month?*

YesNo (I am 13 or younger)
Working With Children Check Full Name*

First Name - as it appears on letterMiddle Name - if a middle name is on shown letterLast Name - as it appears on letter
SRN Number as found on certificate*
The SRN reference number needs to be submitted in this format: xxxxxxxx (ignore the dash)
Expiry*

DayMonthYear
Date
If you do not currently have a WWCC is there any reason you will not be able to obtain one? Please explain.
Volleyball SA Membership

All Volleyball SA suppliers must have a current Volleyball SA membership before commencing work. If you don't have a current Volleyball SA membership, you can apply for a free Associate membership here.
Membership Number*
Provide First Aid Certificate File Upload

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Statement By A Supplier

ALL Volleyball SA suppliers must complete a Statement By A Supplier form before commencing work. If you don't have a Statement By A Supplier form, you can download one here.

When asked, 'Reason/s for not quoting an ABN', be sure to select, 'made in the course or futherance of an activity done as a private recreational pursuit or hobby'.

***PLEASE DON'T FORGET TO SIGN THIS FORM BEFORE UPLOADING***
Statement By A Supplier File Upload*

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Account Holder's Name*
Bank*
BSB*
Account Number*
Other Qualifications - only for Arena Coordinators

The following qualifications aren't required to supply work to Volleyball SA in most cases so are not necessary for referees.

However, if you plan to be 'in-charge' at a venue or some other specified positions (we will let you know), you will need to complete First Aid.
First Aid

Provide First Aid
Provide First Aid Expiry

DayMonthYear
Date
Cardiopulmonary Resuscitation (CPR)

Provide Cardiopulmonary Resuscitation (CPR)
Provide CPR Expiry

MonthDayYear
Date
Other Information
Shirt size*
Declaration - by signing this form you acknowledge that you:

-Understand that all persons over the age of 14 must provide a valid WWCC before commencing any work with VSA.

-Know and understand that those persons required to provide a valid WWCC must do so before payment can be made.

-Understand that should false or misleading information be provided in your registration or during your engagement with VSA your involvement with VSA may be terminated immediately and payment may be forfeited.

-Have read and understand the VSA Working With Children Check Process document.
Signature

Clear
Should be Empty:

Volleyball SA Supplier Form

Personal Information

Working With Children Check

Volleyball SA Membership

Statement By A Supplier

Other Qualifications - only for Arena Coordinators

Other Information