Leichhardt Saints Football Club
PO Box 821, LEICHHARDT, 2040
(page 1 of 2)
www.leichhardtsaints.com
Player Registration 2015
FFA Reg. Number:………………….…
Player Details:
Given Name(s): ......................................................... Surname: ................................................................................
Address: ......................................................................................................................................................................
Suburb: ................................................................................................................ Post Code: .....................................
Age turning during 2015: ............................................ Gender: ........................... Date of Birth: ..................................
Country of Birth: ……………………………………… Nationality: ………………………………………………………….
Are you Aboriginal or Torres Strait Islander? Yes / No
Player history
Club
Team
......................................................................................................................................................................................
......................................................................................................................................................................................
......................................................................................................................................................................................
School (if U18):............................................................................................................................................................
Team Preferences: Team/Coach/Team-mate(s) ………………………………………………………………….
……………………………………………………………………………………………………………...
……………………………………………………………………………………………………………...
PLEASE NOTE: As per LSFC Grading Policy ALL PLAYERS from U8 up should attend GRADING TRIALS.
Custodial Parent/Guardian/Emergency Contact Details (for all players)
Custodial Parent/Guardian/Emergency contact 1
(mandatory)
Parent/Guardian/Emergency contact 2 (optional)
Given Name: ...............................................................
Given Name: ..............................................................
Surname: ....................................................................
Surname: ....................................................................
Address: ......................................................................
Address: .....................................................................
....................................................................................
....................................................................................
Occupation: .................................................................
Occupation: ................................................................
(In case we want to put the hard word on for your
skills)
(In case we want to put the hard word on for your skills)
Player Contact details (or custodial parent/guardian 1)
Home phone: ................................................. Email .....................................................................................................
Work phone ................................................... Mobile ...................................................................................................
Contact details (parent/guardian 2 if different from above)
Home phone: ................................................. Email .....................................................................................................
Work phone ................................................... Mobile ...................................................................................................
These details are required by the Club should it be necessary to contact you, and are also a requirement of
registration with Football Federation Australia.
Please complete page 2 over
Leichhardt Saints Football Club
(page 2 of 2)
Player Registration 2015
PLAYERS DECLARATION:
I, as a player (or as a parent or guardian of a junior player), hereby declare,
 I am applying to Football Federation Australia to register with LSFC as an AMATEUR Player and
agree to comply with its terms (unless otherwise indicated), Statutes and the Laws of the Game.
 I have received a copy of the current LSFC Players Information Handbook
 I agree to abide by the CDSFA Players Code of Conduct, a copy of which is contained within the
LSFC handbook.
 I agree to the terms of accident insurance offered by the Football NSW and JLT Insurance (the
Accident Support Program), a copy of which is contained in the LSFC Handbook.
 I am not under suspension by any sporting organisation,
 I have not contracted or signed to play for any other soccer team this year,
 I am duly qualified to play for this team according to the rules of the Association,
 There are no monies or property owing by me to any Club or Association,
 I have read the above information regarding my details on this form and it is correct and true,
 That I have had the opportunity to read the rules of the Association and will abide by these rules
and any decision(s) of Canterbury and District Soccer Football Association Inc. (CDSFA),
 I am willing, as a player and/or as a parent or guardian of a junior player, to follow directives of
Club Officials and to volunteer when required to ensure the efficient running of the Club,
 I understand that LSFC will undertake to exercise all reasonable care in the conduct of its
activities, but declines to accept responsibility for accidents occurring as a consequence of my, or
my child’s, participation in such activities.
 I understand that I will be included on the LSFC mailing list so I will have all the latest information.
Permission for use of photos on Leichhardt Saints (LSFC) web site:
I grant permission for photos of this registered player, which may be taken during games or events
throughout the football season, to be used in Club publications, including the Club web site. No names
of players under the age of 18 will be used in conjunction with photos when published on the LSFC
web site without separate express permission.
Player Signature: ................................................. ……………………………… Date: .............................
Parent/guardian Co-signature if under 18: ........................................................ Date: .............................
[If you have reason to not to make this declaration, or grant photo permission, please see a club official
at registration]
Special offers for CDFSA, FFA and their partners
 I do NOT want to receive special offers from Football Administrators partners.
Official use only
Player ID
Type of ID
Original sighted
Birth Certificate
Copy obtained
Passport
N/A (returning player)
Drivers Licence/RTA ID
Registration fee of
$
Player Handbook
Issued.
YES
Photo ID
Current File Photo OK
New Photo Taken
Must be read by ALL
Players
Payment
Receipt No
………………………………………..
Received with thanks
Form received and
checked by
Date received (if not reg day):
Processed
(Registrar)
Taken By: ……………………
(initials): ……………..…
………………………………
………………………………
Date Taken: …………………….