AFL Barwon 2015 CLEARANCE APPLICATION FORM

SECTION 1: Player Details

VNA Number League Club Gender

First Name Middle Name Surname Date of Birth

Street Address Suburb Post Code

Home Phone Mobile Email Address

SECTION 2: Clearance Application

Club From

Club To

Reason for Clearance

SECTION 3: Player’s Declaration I hereby seek permission to play with the Club, subject to the application which I have made for a Clearance to the Club being granted and subject to due compliance with the requirements of the League with which the Club is affiliated. I also authorize the league to which I desire registration, to advise my former club of this application. I DECLARE that the above particulars are, to the best of my knowledge, and belief, true and correct. Signature of Player Date / / (If the Player has not attained the age of 18 years) Parent/Guardian Signature Signed (President/Secretary) for Netball Club Date / /

Office Use Only Date Received from Club/Player: Date / /

Clearance Approved: Reason if not cleared: ___________________________________________________________________

Yes No