Please note: This form is only to be completed by teams officially entered into a league ; it is NOT an Expression of Interest form or Team Application form. Furthermore, a minimum of 5 players must be listed on this form in order for your team's registration application to be considered valid.

TEAM DETAILS

TEAM NAME (Required)

TEAM SHIRT COLOURS (Required)

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

COMPETITION CATEGORY (Required)
MEN'SMIXEDWOMEN'S

COMPETITION NIGHT (Required)
SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAY

COMMENCEMENT MONTH (Required)
JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER

TEAM CAPTAIN

TEAM CAPTAIN - FULL NAME (Required)

EMAIL (Required)

PHONE NUMBER (Required)

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS (Required)

SUBURB (Required)

Post Code (Required)

VICE CAPTAIN

VICE CAPTAIN - FULL NAME (Required)

EMAIL (Required)

PHONE NUMBER (Required)

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS (Required)

SUBURB (Required)

Post Code (Required)

PLAYER 3

FULL NAME (Required)

EMAIL (Required)

PHONE NUMBER (Required)

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS (Required)

SUBURB (Required)

Post Code (Required)

PLAYER 4

FULL NAME (Required)

EMAIL (Required)

PHONE NUMBER (Required)

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS (Required)

SUBURB (Required)

Post Code (Required)

PLAYER 5

FULL NAME (Required)

EMAIL (Required)

PHONE NUMBER (Required)

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS (Required)

SUBURB (Required)

Post Code (Required)

PLAYER 6

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 7

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 8

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 9

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 10

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 11

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 12

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 13

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 14

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

PLAYER 15

FULL NAME

EMAIL

PHONE NUMBER

ALT. PHONE NUMBER

DATE OF BIRTH

ADDRESS

SUBURB

Post Code

IMPORTANT INFORMATION REGARDING REGISTRATION FOR A FUTSAL SUPER 5S LEAGUE

1. Each team must provide a Team Captain who will be contacted by Futsal Super 5s in regards to league and season information, league fixtures, disciplinary matters and/or any other competition concerns. It is the Team Captain’s responsibility to ensure that all relevant information regarding the competition, not limited to email notifications, is communicated to other members of the team. Furthermore, it is the responsibility of the Team Captain to ensure an active email address and phone number exists with Futsal Super 5s.

2. Payment of the registration fee *if applicable* (along with the redeemable bond fee where applicable) must be made IN FULL by a team’s second match in a league season at the league venue in which your team has registered. Payment is to be made directly to the Competition Administrator at the league venue or via an online banking transfer (with prior approval).

3. At no stage are Futsal Super 5’s 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.

4. 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.

5. Futsal Super 5s encourage all players and others covered by this policy to consider private health insurance. Futsal Super 5s is not and does not represent itself as a registered insurance broker. Participants enter this competition at their OWN RISK - No Player Accident Cover exists.

6. During the course of your team's 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 the organisation's promotional purposes, including for use on the website, Facebook page and YouTube (public sites). Your team agrees and accepts that filmed and photographed material may be reproduced for those purposes. Filming and Photography of matches primarily occurs in Grand Final periods and promotional videos include (with prior consent) first names and initials of each participant. Registered members of your team can opt-out from all media by directing an email to info@super5s.org or calling our Administration line on 0433 000 444.

7. Prior to submitting this form, Rules of Competition are to be read in full, with any enquiries to be directed to the Futsal Super 5s Management Team: info@super5s.org

(FULL NAME) declare that I have read the Rules of Competition pertaining to the Futsal Super 5s league I am entering and agree for myself and team members 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 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/INSURANCE ON BEHALF OF THE TEAM