BAIRNSDALE AND DISTRICT JUNIOR FOOTBALL ASSOCIATION INC.

117 Drevermann St. Bairnsdale. Vic. 3875

MATCH SECRETARY: ROD TWINING

PHONE: 03 51527300 (H) MOBILE:0407347727 FAX: 03 51 527303 E-MAIL: egfl2004@bigpond.net.au

Special Circumstances Registration Permit For a player to play outside their age group

WorkSafe VCFL Registration number:…………………………………………………….

Player Name:………………………………………………. Date of Birth……/……./…...

Address:…………………………………………………………………………………….

Club:…………………………………………. Age group last played in:………………...

Permit requested to play in age group:……………………….

For year…………………...

All parties to this Special Circumstances Registration Permit confirm they have met and discussed the reason the player has requested to play in this age group. All parties have agreed that after due consideration it was deemed appropriate and safe for the player to be granted a Special Circumstances Registration Permit for season……………………. It is also agreed all parties, including the players club, league and the VCFL have provided a duty of care by undertaking a meeting of all involved and after such meeting agreed it was appropriate for this player to play in this age group for this season. The player agrees to abide by the local league rules applying to players approved for a Special Circumstances Registration Permit and a copy of such rules has been provided to the player and the players club. The Club, league or VCFL has the right to revoke the Special Circumstances Registration Permit at anytime.

Signed: Player:……………………………………………………….

Parent(s)……………………………………………………..

Players club Representative:…………………………………

League Representative:………………………………………

Date:……/……../…….