UWA SUMMER SOCIAL SPORTS
NOMINATION FORM
Sport/Team Details
updated 26/11/15
Team name________________________________________________________________________
MON
Basketball
THU
TUE
Mix
Fast 5
Netball
Mix
Doubles
Tennis
Mix
Team Manager Details
Name____________________________________________
DOB________________________
Student/Staff No___________________________________
Gender______________________
Email____________________________________________________________________________
Affiliation to UWA__________________________________
Phone_______________________
Address__________________________________________
Postcode_____________________
Secondary Contact Contact
Name____________________________________________
Phone_______________________
Email____________________________________________________________________________
Team List
Player Name
UWA Staff/Student
No.
Total
Gender
Affiliation
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
M
F
Student
Staff
Alumni
Community
Payment Details
Basketball
Netball
Tennis
Upfront
$300
$300
$96
Week-to-Week
$50
$50
$16
-
Bib hire: $10
-
Sport
Extras
Up Front Payment – Teams may choose to pay for the entire season upfront. Payment for the
season will be calculated by the number of week of competition (6) multiplied by the game fee
($50). Payment must be complete to confirm registration.
Week-to-Week Payment - Teams may pay for the season week-by-week.
Nomination Fee and Forfeit Bond are not required for UWA Summer Social Sports.
UWA Social Sports Agreement
HOW TO NOMINATE
Complete ALL sections of this form. Return form and pay the nomination fee and forfeit bond at the UWA Recreation and Fitness Centre. The forfeit bond
amount will be held to cover the cost of the first forfeit of the season. If no forfeits occur, this amount will either be refunded or will cover the cost of the last
game of the season. This amount will be kept if a team withdraws.
DECLARATION
I warrant and declare that I have, on behalf of all the members of the team, the authority to make this declaration. I agree that I/my team participate in this
competition at my/our own risk. Accordingly, on behalf of the team named on this form, I declare that the team will participate in all matches programmed
for the duration of the season (including finals matches) and undertake to honour any fines that may be imposed as a result of this team withdrawing or
causing a match to be forfeited or any other fines allocated by UWA Sport (must read General Rules at www.sport.uwa.edu.au/sports-and-teams/uwa-socialsports#rules).
Authorised by all members of the team, I acknowledge that the members of the team agree jointly and individually to fully indemnify UWA Sport Pty Ltd and
its staff, representatives and contractors, against any and all claims arising which may be made against them as a result of our team’s use of the services,
facilities, equipment or apparatus at UWA Sport or our presence at UWA Sport or its immediate surrounds.
I hearby agree to the above terms, and to not to hold the organisers, UWA Sport Pty Ltd, and/or employers liable for any personal injuries or accidents arising
from participation in any UWA Sport class or activity unless the organisation is deemed negligent. I also confirm that I am physically and mentally capable to
undertake the class or activity I will involve myself in.
Upfront Cost_______________ _____ Signature______________________
Date:___________
Office Use
Received by__________________________________
Amount__________
Date___________
UWA Sport Pty Ltd | ph (08) 6488 2286 | fax (08) 6488 4725 | admin@sport.uwa.edu.au | www.sport.uwa.edu.au