SWA manual Clearance Form

 

Softball WA
Postal: PO Box 450, Mirrabooka WA 6941
Tel (08) 9349 9911
Fax: (08) 9345 3553
Website: www.wa.softball.org.au
E-mail: admin@softballwa.org.au

APPLICATION FOR CLEARANCE

TRANSFER CLUB TO CLUB

 

  1. PLAYER’S NAME: .......................................................................................................................................................

 

  1. ADDRESS: ...................................................................................................................................................................

 

                     .................................................................................................................................... P/CODE: ...............................

 

  1. EMAIL ADDRESS: ………………………………………………………………………………………………………………………………………………………

 

  1. TELEPHONE: …………………………………………………………………………………………………………………………………………………………….

 

  1. DATE OF BIRTH: .........................................................................................................................................................

 

  1. NAME OF AFFILIATED ASSOCIATION: .......................................................................................................................

 

  1. NAME OF CURRENT REGISTERED CLUB: .................................................................................................................

 

  1. NAME OF REQUESTED AFFILIATED ASSOCIATION: .................................................................................................

 

  1. NAME OF REQUESTED REGISTERED CLUB: ...............................................................................................................             

 

                   ____________________________                                                         _____________________________________

                    (Date)                                                                                                       (Signature of Applicant)

                              Signature of Parent/Guardian if under 18 _______________________________________

  1. APPLICANT REQUESTING CLEARANCE MUST EMAIL THIS SIGNED DOCUMENT TO SWA TOGETHER WITH A $6 FEE, (EFT TO)

ANZ BSB: 016353 ACCOUNT NUMBER: 262446416. PLEASE USE REFERENCE: “CLEARANCE AND SURNAME”

 

DATE STAMP OF CLEARANCE APPLICATION

 

 

                              THIS CLEARANCE WILL BE AUTOMATIC IF

                              NOT ANSWERED WITHIN 21 DAYS OF THE

                              DATE STAMP INDICATED.

 

 

                              SWA OFFICE SIGNATURE: __________________________________________

 

 

 

  1. THE COMMITTEE OF ....................................................................................... CLUB HAS CONSIDERED THE CLEARANCE REQUEST OF THE ABOVE APPLICANT AND HAS:

(A)                     GRANTED

(B)                     NOT GRANTED FOR THE FOLLOWING REASON/S: .................................................................................................

 

……………………………………………………………………………………………………………………………………………………………………………………………………………

 

SIGNATURE AND POSITION OF THE AUTHORISED PERSON: ...........................................................................................................

 

…………………………………………………………………………………………………………………………………………………………………………………………………………..

 

 

  1. ONCE APPLICANTS CLEARANCE HAS BEEN GRANTED BY CURRENT CLUB, THIS FORM WILL THEN BE EMAILED TO THE NEW AFFILIATED CLUB.

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