2024 BASL Dispensation Form

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Club Name* This field is required.
Border Raiders FC
Castlemaine Goldfields FC
Deniliquin Wanderers
Epsom FC
FC Eaglehawk
Golden City SC
Kyneton District SC
Latrobe University SC
Shepparton SC
Shepparton Lushi FC
Shepparton South SC
Shepparton United SC
Spring Gully United SC
Strathdale SC
Strathfieldsaye Colts United FC
Swan Hill SC
Tatura SC
2
Club Contact Details* This field is required.
Contact Name
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Please enter your email
Club Role (i.e. President, Secretary, Junior Co-Ordinator)
3
Player Details* This field is required.
Player Name
Date of Birth
FFA Number
4
Competition Seeking Dispensation* This field is required.
Central Victorian Seniors
Central Victorian Juniors (Competitive) - Mixed
Central Victorian Juniors (Competitive) - Girls
Central Victorian Non-Competitive
5
Does your club have a team within the players correct age group?* This field is required.
YESNO
6
Is the request to play up beyond the maximum age allowed under the Rules of Competition for both Seniors and Juniors?
YESNO
7
The player agreement at the link below must be completed and attached to this application:

Player Agreement
8
Is the application to play down an age group as allowed within the Rules of Competition?If "Yes" please provide the medical information (where applicable) or additional information to enable assessment of the application.
YESNO
9
Is the medical information required attached? (Where applicable)As required under the Rules of Competition for playing down an age group.
YESNO
10
Additional InformationPlease provide any additional information in the space below.
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Ok
Ok
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File UploadEnsure any necessary attachments as required are provided here (i.e., Medical Information, Player Agreement).
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Max. file size: 10.6MB
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Note: Players seeking a dispensation (where required and within the acceptable reasons) must NOT play in any competition outside the Rules of Competition until approval in writing has been received from BASL.

Please ensure all required information and attachements are completed prior to submission.

Incomplete requests will be returned to the requesting club and not processed.
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Thank you for your submission. BASL will provide a answer after the review of information provided.
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