AWFA Form 16 Accredited Coach Registration

"*" indicates required fields

Name*
MM slash DD slash YYYY
DD slash MM slash YYYY
I am or I am not currently registered with another club or association (Please tick appropriate box)*
I am or I am not currently disqualified or suspended (Please tick appropriate box)*
Expiry Date
DD slash MM slash YYYY

Note:

You are required to complete NSW working with children volunteer declaration. (https://www.service.nsw.gov.au/transaction/apply-working-children-check) or Working with Children Check (Victoria) (http://www.workingwithchildren.vic.gov.au/). This information needs to be provided and held by your Club. You are required to register as a non-player coach in the FFA Online Registration System.

DECLARATION

I hereby consent to participate under the jurisdiction of Albury Wodonga Football Association Inc as a NONACCREDITED COACH and pledge to observe all the rules and regulations of Albury Wodonga Football Association and Football NSW Ltd or Football Victoria Ltd. I have read and agree to abide by the “FFA Codes of Behaviour” as provided to me. I acknowledge that I accept the facilities (which includes change rooms and other relevant facilities) at any ground at which a match is played in the condition “as is” and releases and indemnifies Albury Wodonga Football Association in respect of any liability whatsoever arising out of the nature or condition of those facilities. I accept that soccer is a recreational activity that involves a significant risk of physical harm and I as the non-accredited coach/non-accredited coach’s parent accept that you have warned me of the risk of injury. I herby declare that all the information submitted on this form is true and correct.
Club President*
MM slash DD slash YYYY