Thank you for your interest in registering for the 2022 season at West Torrens Birkalla.  This form is appropriate for all players wanting to register to play for the Senior Women's Competition in 2022.  We aim to have teams represented in Div 1, Div 2 and WSL/WNPL (pending season 2021 results).



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* 1. Player First Name

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* 2. Player Surname

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* 3. Home Address

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* 4. Player Email Address

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* 5. Player Mobile Number

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* 6. Birth Date (dd/mm/yyyy)

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* 9. Player's FFA Number

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* 10. Emergency Contact Full Name

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* 11. Emergency Contact Email Address

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* 12. Emergency Contact Phone Number

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* 13. Do you suffer from any of the following medical conditions?

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* 14. If you have indicated that you suffer from a medical condition, please make any further comments that may be necessary, and may provide further information on management of the condition.

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* 15. I hereby agree(s) that West Torrens Birkalla Soccer Club ("The Club") including any of its officers and/or members shall not be held responsible for any accident, illness or injury sustained by me while playing at, or attending any function with The Club.

I understand that The Club carries only basic player’s insurance (provided through registration with FFA) and that it is my responsibility to arrange additional insurance cover.

The Club recommends that every player takes out their own private health insurance including ambulance cover. Although players are covered by the FFA Group Personal Accident Insurance whilst playing or training, the Club will not be liable for any cost not covered by the FFA insurance that shall be for the account of the players.

I also give my permission for The Club to arrange medical attention on my behalf, which may be deemed necessary including ambulance transport, and I agree to pay for all such costs incurred.

The Club agrees that it will do its utmost to contact the emergency contact, if possible, prior to seeking medical treatment, but I understand and accept that it may not be possible to do so in all circumstances.

The Club agrees to contact the emergency contact as soon as it is practicable to do so.

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* 16. Player "signature" - please state your name

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