Perth Softball Leagues

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.

SWA Clearance Form.docx