BLACKTOWN CITY NETBALL ASSOCIATION INC.
2015 STATE CHAMPIONSHIP PLAYER SELECTION/CONSENT
APPLICATION FORM
(Please complete all sections in full)
All information on this form will be treated as confidential.
PLAYER DETAILS:
Player Name: _______________________________________________________________________
Address:
_______________________________________________________________________
Post Code:
_________________________
DOB: __________________________________
Mobile:
_________________________
School: ________________________________
Team/s applying for (please tick):  U/17
U/19 OpensO/35 O/40 O/45
PARENTS/GUARDIAN DETAILS
Parents/Guardian Name:________________________________________________________________
Home Phone:___________________________
Mobile: ________________________________
Work: _________________________________
Medicare No: __________________________
Email:_________________________________
Emergency Contact Name: ______________________________________________________________
Mobile ____________________________________
Phone: ________________________________
Work: ________________________________________
Their relationship to you:
___________________
I understand that Blacktown City Netball Association Inc. will not meet the cost of any medical, dental
or hospital service required as a result of any injury occurred as a member of Blacktown City Netball
Association Inc team and it is my responsibility to ensure that I have adequate Private Health Insurance
and extra cover at all times.
PLAYER PROFILE
Current Netball Association________________________________________________________
Height (cm):
_________________________
I am agreeable to being considered for other positions
Current Playing Level:
Player Position/s: 1__________ 2 __________
YES/NO
________________________________________________________________
Are you a current Financial member of your Club, Association and Netball NSW
YES/NO
If no, provide Details: _____________________________________________________________
EMPLOYMENT/EDUCATON STATUS
Full time or part time employment as: _______________________________________________
Studying: ________________________________________________________________________
SPORT DETAILS
Please detail your netball performance at Association, State or National competitions in recent years.
Association
____________________________________________________________________
State Honours
National Honours
___________________________________________________________________
________________________________________________________________
OTHER SPORTING COMMITMENTS:
Other sports/Interests
__________________________________________________________
SPORTS INJURIES
Have you sustained any injuries in the past two years: YES/NO
If yes, please list the following: type of injury (ie sprain, dislocation, tear, fracture, surgery) approximate
date of injury and the treatment received by: (ie physiotherapy, surgeon)
BCNA Club that will be endorsing my Application for 20___: Club: ___________________________
BCNA reserves the right to select or not select any athlete based on its
own determinations and is not obliged to provide any information to any
athlete or any party associated with an athlete concerning its decision.
Signature of Applicant: _____________ Signature of Guardian: _______________
Date:
______________________ Date:
________________________
To the best of my knowledge, all information on this form is correct.
Failure to disclose any relevant information may jeopardize your
selection into the team.
Signature of Applicant: _____________ Signature of Guardian: _______________
Date:
______________________ Date:
________________________
Nominations close Thursday 5pm 9th April 2015
Return to:
Phone:
[email protected]
(02) 9622 9706
Fax: (02) 9622 8867
You will not receive confirmation of receipt of your application however
you may contact the BCNA Administrator to confirm that your application
has been received.
BLACKTOWN CITY NETBALL ASSOCIATION INC.
REPRESENTATIVE PLAYERS’ AND OFFICIALS’ CODE OF CONDUCT
Attachment 2
All players and officials must be prepared, where applicable, to abide by the following:
1. I agree to abide by all Association Representative By-Laws and any other regulations as set down by
the Association
2. I agree to give priority to Representative Netball commitments, including attendance at
nominated Association events
3. I agree to attend and undertake all training required by the Coach, to attend all training and fitness
sessions, and I acknowledge that attendance at Rep Netball training takes precedence over other general
sporting commitments.
4. I agree to notify the Coach and/or Manager in advance of any absences, stating reasons. If necessary,
I may consult the Representative Coordinator for guidance.
5. I agree to refrain from smoking and/or consuming alcohol while Association events are in progress.
6. I will participate in the Opening Day march past wearing Association uniform as directed by
the Representative Coordinator, with approval from Council on an annual basis.
7. I will wear the Association representative uniform for the State/State Age march past and presentation at
Carnivals and Championships and for State League matches and on any other occasion as required by
the Association, and acknowledge that the black training shorts and approved training top are not
permitted on these occasions, apart from warming up/down for matches.
8. I am aware of the items which make up the Association representative uniform for my age group/team
(see over for uniforms for players and officials).
9. I will always be appropriately attired in approved representative clothing when representing the
Association at any game, carnival, championship, fixture event or other representative commitment.
10. I undertake to be available for the whole of the State/State Age Championships, all nominated
Carnivals and all representative matches.
11. I agree to travel to and from Carnivals and Championships in transport organised by the
Association whenever transport is provided.
12. I agree to accept the decisions of the Coach as to the selection of the team to play in each match, and
to accept the directions of the Manager or other Association Official.
13. I understand that I am insured under the insurance scheme of Netball NSW and I am familiar with
the provisions of this cover. I understand that I may take out additional cover at my own expense.
14. I agree at all times to uphold the dignity and good name of the Association and to promote the game of
Netball in NSW.
15. I agree to meet all financial obligations, as outlined in the proposed cost form, by the due date.
I, ____________________________________________ have read the Blacktown City Netball Association’s
Representative Code of Conduct, and I agree to observe all conditions as provided in the Code of Conduct as a
condition of my selection/appointment to the ___________________ team.
Signed___________________________________
Player/Official
Signed_______________________________________
Parent/Guardian (if player under 18 yrs)
Date _____________________________
This document is to be returned to BCNA Office Administrator - email [email protected] or fax (02) 9622 8867
2015 Senior Player Selection Application Form – Updated April 2015
BLACKTOWN CITY NETBALL ASSOCIATION INC.
PHOTOGRAPHIC AND MEDIA CONSENT FORM
SENIOR REPRESENTATIVE PLAYERS
Attachment 3 – PLEASE PRINT
I agree to allow Blacktown City Netball Association to use my photograph(s) taken:
_____________________________________________________________________________________
(Print Name)
Contact Number: ______________________________________________________________________
at any match/event played by Blacktown City Netball Association Representative Player/Teams at any
venue.
These photograph(s) may be published on the Blacktown City Netball Association website
www.blacktowncity.netball.asn.au, in Local Papers and used to promote the Blacktown City Netball
Association for the betterment of the game in the community.
PARENT/GUARDIAN CONSENT
Parent/guardian name (print): _____________________________________
Parent/guardian signature: ________________________________________
(under 18yrs)
Date: ___________________________________________________________
PLAYER CONSENT
Player signature: ________________________________________________
(over 18yrs)
Date: ___________________________________________________________
This document is to be returned BCNA Office Administrator via email [email protected] or fax (02) 9622 8867
2015 Senior Player Selection Application Form – Updated April 2015
BLACKTOWN CITY NETBALL ASSOCIATION INC.
CLUB TRANSFER DECLARATION FORM
Attachment 5 - PLEASE PRINT
Players transferring membership must complete this declaration and obtain Club endorsements.
Our Club _____________________________________endorses the release of our member
________________________________________to transfer membership to________________________________
(Player Name)
(Club Name)
effective immediately upon BCNA selection.
Upon signing this release our club declares the player is currently financial and relieved of further obligation.
Club Secretary:___________________________________________Date:__________________________________
Signature:_______________________________________________
(Players transferring membership must complete the above declaration and obtain Club endorsements)
NB: IMPORT RULE 7.8 APPLIES TO ALL TRANSFERRING PLAYERS
BCNA BY-LAWS Clause 7 Registration - General
SUB CLAUSE 7.8 ‘IMPORTS’
a)
An ‘import’ is any player selected in the Association’s junior or senior representative or development
teams for the current year, transferring membership to a new club for the following year.
b)
A club may register one ‘import’ per junior or senior team in the Winter Competition.
c)
Unlimited imports are permitted for Night Competition, however, imports for the following Winter
Competition will be based on registrations for the preceding Winter Competition.
d)
Upon nominating for selection an import player is required to complete and submit the BCNA
player transfer declaration attachment and obtain the signed club endorsements required to
release and transfer existing club membership.
e)
An import must be identified on team registration forms with a # as well as an * See also By-Law 8.3.
f)
In exceptional circumstances a player may appeal to the Executive to be exempted from the import
ruling.
* A FULL VERSION OF THE BCNA CONSTITUTION AND BY-LAWS ARE AVAILABLE ON THE BCNA WEBSITE
www.blacktowncity.netball.asn.au
This document is to be returned to BCNA Office Administrator - email [email protected] or fax (02) 9622 8867
2015 Senior Player Selection Application Form – Updated April 2015