LLC Adult Sports Nomination Form

Team Name:*

Team Captain's Name*

First NameLast Name

Team Captain's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Team Captain's Phone Number:*

Team Captain's Email:*

The nominated team captain must be 18 years of age or over.

Is the team captain 18 years of age or over?:*

YesNo

Team Captain's Date of Birth:*

Date

Adult Sports Competitions are for participants who are 16 years and older.

The team captain takes responsibility for ensuring that the above conditions are followed.

Does the team captain agree to abide by the above condition regarding the age restrictions of players in our competitions?:*

YesNo

Secondary Contacts Name*

First NameLast Name

Secondary Contact's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Secondary Contact's Phone Number:*

Secondary's Email:*

Sport:*

Grade: (request only)*

ABC

Please note: If there are not enough teams to generate a grade, teams will be combined within the nearest grade available on that night and the grade may or may not split for finals.

Team Shirt Colour:*

Team Bottoms Colour:*

Team Bib Colour:*

Player Registration:

Minimum of 5 players required.

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 minimum number of players for each sport are as follows:

Basketball - 5 players minimum
Netball - 7 players minimum
Soccer - 5 players minimum

As all the below fields are required fields, if you are unable to fill a full team of 10 players, please enter N/A in the remaining 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:

How did you hear about our competition?

Word of MouthRadioNewspaperOther

Is there another competition you'd like to see run at LLC?

Terms and Conditions

The team organiser is responsible for reading and agreeing to the terms and conditions, which are applicable to all players and spectators who represent their team.

The team organiser warrants that the team (named on this form) is physically fit and able to engage in exercise and fitness programs. This applies to any additional players or fill in players throughout the season. The team organiser is responsible for the team to participate in all matches programmed for the duration of the season, including finals matches, and will honour all warnings and suspensions that may be imposed on this team by the Management of LLC.

The team organiser will receive electronic updates on Leisure Centres programs and events and that the team organiser can unsubscribe from these updates, if they wish.

General

The team organiser is responsible for ensuring their team members and spectators understand and abide by the team sports bylaws and sport specific rules. These are available for viewing by emailing llc.sports@harvey.wa.gov.au or copies can be obtained from the Sports Coordinator.
The teams must abide by the Leisure Centres Conditions of Entry, located at the entrance and throughout the facility.
The Shire of Harvey provides Public Liability insurance. Personal insurance is the responsibility of the individual. All team members play at their own risk.
To participate in the senior competitions, players must be 16 years or older.
Security cameras operate within the facility; patrons may be filmed.

Team Nominations

This is an application to join one of the social competitions at the LLC and no guarantee is given that this application will be successful. Where teams cannot be included, they will be notified, and any payment(s) made will be refunded.
The Advance Game Fee (AGF) is a two-game advanced payment that covers the cost of the last two games before finals. This payment is non-refundable should the team withdraw from the season.
The AGF payment is required upon nomination – team nominations cannot be accepted until payment has been received.

Forfeits and Withdrawals

All forfeits will incur a forfeit fee. If less than 24 hours’ notice is provided (business days only) the team will incur a fee of two game fees (the team’s game fee plus the oppositions). If more than 24 hours’ notice is provided the team will incur a fee of one game fee.
No shows - If your team does not participate in a scheduled game without providing sufficient notice, the team will be charged double the game fee.
Forfeit fees require payment within 7 days of the forfeit. Game points will not be allocated to any teams with forfeit fees outstanding.
A team may withdraw from the competition by the team organiser provided written notification of the withdraw to the Sports Coordinator with 7 days’ notice of the withdrawal. Any AGF that has been paid will be forfeited.

Player’s Code of Conduct

The team organiser is responsible for ensuring their team members and spectators understand and abide by code of conduct, the Conditions of Entry, team sports bylaws and sport specific rules.
Players arguing with an umpire will not be tolerated. If a player disagrees, the team organiser can raise concerns with the Sports Supervisor on behalf of their team during a break or after the game.
Verbal abuse toward umpires and other players, or deliberately distracting or provoking an opponent are not acceptable or permitted behaviours.
Swearing, whether it is direct or in-direct, will not be tolerated.
It is expected that all players treat all participants with respect. Bullying or taking unfair advantage of another player will not be tolerated.
Any breach of the player’s code of conduct or the Leisure Centres Conditions of Entry may result in disciplinary action imposed by the Leschenault Leisure Centre Management. Management reserves the right to issue warning letters and suspend players, teams and / or spectators from the competition.

Game Fees and Charges

15-week season, 13 general rounds, 2 weeks’ finals.
Advanced Game fee due with nomination (covers last 2 games before Finals).
Payment options, Weekly Game Fee paid prior to game or season fees paid by week 3 in full will include 10% discount, failure to pay by week 3 no discount will be appllied.
Finals to be paid weekly prior to your game.
Forfeit fees:
- Less than 24 hours’ notice will be charged at double the regular game fee.
- 24 hours or more notice will be charged the regular game fee.
- No shows - If your team does not participate in a scheduled game without providing sufficient notice, the team will be charged double the game fee.

Declaration - the declaration must be signed and dated for this nomination to be accepted. By ticking the box below, I agree to the following:

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.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.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.

4. 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 oweI 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: