LLC Adult Sports Nomination Form

LLC Adult Sports Nomination Form

Summer Season 2025-26
I'm nominating a team for*

Men's Basketball - TuesdaysLadies Netball - WednesdayIndoor Soccer - Wednesday
Team Name:*
Preferred grade*

A gradeB gradeC grade
- All players must be at least 16 years of age
- All grading requests will be considered but cannot be guaranteed.
- If there are insufficient teams to make up a grade, teams will be combined with the nearest grade.
- Splitting of grades for finals will be at the discretion of the Sports Coordinator
Team Shirt Colour:*
Team Bottoms Colour:*
Team Bib/Number Colour:*
How did you hear about our Adult Sports Competition

I'm a previous player at LLCFriend/FamilySocial mediaWebsiteIn-house advertising at LLC
Team Captain Details

Must be 18 years or older
Name

First NameLast Name
Phone Number:*
Date of Birth (must be 18 years or older)*

MonthDayYear
Date
Email:*
Secondary Contact Person
Name

First NameLast Name
Phone Number:*
Email:*
Number of Players to be Registered:
Important

To ensure that our Sports Coordinator receives all the essential information required to sign your team up for our competition, please ensure all the below fields are completed.

The following indicatest the minimum number of players to nominate as a team:
- Basketball - 5 players minimum
- Netball - 7 players minimum
- Soccer - 5 players minimum
All player registration fields must be completed. Put N/A if you are unable to complete all fields.
PLAYER 1
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 2
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 3
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 4
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 5
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 6
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 7
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 8
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 9
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
PLAYER 10
Name*

First NameLast Name
DOB:*
Phone:*
Do you give consent for your photo to be taken for promotional purposes by LLC staff?*

YesNo
Played in an LLC Comp previously?*

NoYes (provide previous team name)
Previous Team Name:
Is there another competition you'd like to see run at LLC?
Declaration
1. To abide by the rules of Leschenault Leisure Centre.
2. That I have read and understood the Conditions of Registering a Team and the Bylaws
3. The Shire of Harvey will not be responsible for any injury suffered by either participant or non-participant members of the group while using facilities: whether the injury be self-inflicted, caused by another member of the group, or caused by another person not associated with the group.
4. The Shire of Harvey will not be liable in any way for any loss of, or damage to the property of members of the group, whether members or non-members of the group cause the loss or damage.
5. The above does not apply to the extent that any injury, loss or damage is caused or contributed to by the willful negligent or other unlawful act of omission of the Shire of Harvey or any of its employees, officers, agents or contractors.
6. Photos will be taken at any time for promotional purposes by LLC staff. It is the responsibility of players to advise LLC staff if they do not wish for their photo to be taken.
7. I warrant and declare that I have, on behalf of all team members named on this form the authority to make this declaration. I declare that we will participate in all matches programmed for the duration of the season (including finals matches) and undertake to honour fines that may be imposed as a result of this team causing a match to be forfeited and any fees associated with the collection of fees owe
8. I further again, being authorised by the team and on behalf of all members of the team, agree to at all times, fully indemnify the owners, agents and employees of the Leschenault Leisure Centre against any and all claims, however arising, which may be made against them as a result of our team’s use or participation in or presence within the Leschenault Leisure Centre.
Declaration:

I have read and agree to the declaration above
Enter text:*
ADMIN USE ONLY
Received on:
Staff Name:
Nomination Fee Paid:

YesNo
Receipt Number:
Should be Empty:

LLC Adult Sports Nomination Form

Team Captain Details

Secondary Contact Person

Declaration