Futsal Super 5s Individual Registration Form: Use this form if you are preparing to participate as a Guest Player in a Futsal Super 5s sanctioned competition OR if you need to be added to an already submitted Team Registration Form.

TEAM NAME (required)

COMPETITION VENUE
BOX HILL - AQUALINK COMPLEXBOX HILL - KINGSWOOD COLLEGEBURWOOD (HQ)CAMBERWELL (HQ)CARLTON NORTH (HQ)COLLINGWOODHAWTHORN (HQ)VERMONT SOUTH

COMPETITION CATEGORY
MEN'SMIXEDWOMEN'S

COMPETITION NIGHT
SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAY

DATE OF COMMENCEMENT (I.e. Date you will play your first match with your team)

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH :

ADDRESS:

SUBURB :

POST CODE

CONDITIONS OF ENTRY INTO A FUTSAL SUPER 5S SANCTIONED COMPETITION:

1. At no stage are Futsal SUPER 5S under any obligation to accept, maintain or re-new team applications (or allow offending players to return to a competition) and past behaviour may be taken into account when an application to register or re-register is received.

2. All participants and spectators must adhere to the conditions or rules of the venue in which your league is held (i.e. no smoking, no marking shoes, no alcohol, adhering to car park speed limits). Any breach of conditions and/or anti-social behaviour will be dealt with accordingly by venue management and may result in expulsion from the respective Futsal SUPER 5S league.

3. Participants enter this competition at their OWN RISK - No Player Accident Cover exists.

4. During the course of your participation in the competition you are entering, Futsal SUPER 5S-appointed Media staff may take photographs and film footage of you and your team members and may use the photographs and/or film footage for promotional purposes, including for use on the website, Facebook page and YouTube (public sites). You and your team agree and accept that filmed and photographed material may be reproduced for those purposes. Filming and Photography of matches primarily occurs on Grand Final nights and any promotional video includes (with prior consent) first names and initials of each participant. You are permitted to opt-out by directing an email to info@super5s.org or calling our Administration
line on 0433 000 444 and we respectfully request that any opt-out request is directed to our Administration team in a timely manner.

5. Prior to submitting this form, you agree to read the Futsal SUPER 5S Rules of Competition in full, with any queries to be directed to the Futsal SUPER 5S Management Team : info@super5s.org prior to participating.

DECLARATION

(FULL NAME) ) declare that I have read the Rules of Competition and Insurance documentation pertaining to the Futsal SUPER 5S league I am entering and agree to abide by them. I understand the league I am entering operates under a low-tolerance policy and if at any point behaviour, conduct or commitment is questioned, the Directors and Officials have the ability to remove me or my team from the league. Furthermore, I will not hold the Directors or Officials of Futsal SUPER
5S responsible for any injury, damage or loss of property belonging to myself or members of my team.

TICK THIS BOX TO ACCEPT THE RULES OF COMPETITION AND CONDITIONS OF REGISTRATION