Host a football4all Program: Application Form Application Form football4all This form is for any existing or new football4all club programs who wish to operate a program under Football NSW. The information provided will be on the Football NSW website in the football4all section to provide football information to the community. For more information about this process please contact Annabel Meadley on (02) 8814 4459 or email annabelm@footballnsw.com.au.Official Name of football4all Program*Football Club in Which the Program Operates*Association in which the Club program operates*Albury Wodonga Football AssociationBankstown Football AssociationBathurst Football AssociationBlacktown & District Soccer Football AssociationCanterbury & District Soccer Football AssociationCentral Coast FootballDubbo & District Football AssociationEastern Suburbs Football AssociationEurobodalla Football AssociationFootball RiverinaFootball South CoastFootball Wagga WaggaGranville & District Soccer Football AssociationGriffith & District Football AssociationHighland Soccer AssociationHills FootballLithgow & District Football AssociationMacarthur & District Football AssociationManly Warringah Football AssociationNepean & District Football AssociationNorth West Sydney Football LtdNorthern Suburbs Football AssociationOrange & District Football AssociationShoalhaven & District Football AssociationSouthern BranchSouthern Districts Soccer Football AssociationSouthern Tablelands Football AssociationSt George Football AssociationSutherland Shire Football AssociationSydney Amateur LeagueWestern NSW FootballWestern PlainsApproval of program from Member Association (insert contact name)*Program Coordinator Name* First Last Program Coordinator E-mail Address* Program Coordinator Contact Number*Alternative Program Coordinator Name* First Last Alternative Program Coordinator E-mail Address* Alternative Program Coordinator Contact Number*What day(s) of the week does the program run?*MondayTuesdayWednesdayThursdayFridaySaturdaySundayWhat time does the program run?* : HH MM AM PM What time does the program end?* : HH MM AM PM Program Location* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Age Grade*5-1818+All AgesOtherCost*Example: $10/session, $50 Registration, FreeClub Program Website* Facebook Link (Optional) Program Commences* Date Format: MM slash DD slash YYYY Program Concludes* Date Format: MM slash DD slash YYYY Please Provide an Overview of the Program*Program is designed to give kids with special needs or a disability a chance to play football in a fun and enjoyable environment. The program is for children aged 5 and above We welcome players who have never played before Please indicate any councils, organisations or charities supporting the programAbilities welcome to participate in the program*AllIntellectual DisabilityPhysical DisabilityAmputeeCerebral PalsyVisual ImpairmentSensory Impairment (e.g. Autism Spectrum Disorder)Learning ImpairmentPowerchair or Wheelchair UserNeurological ImpairmentOtherIf other, please specifyClub Member Protection Information Officer (MPIO) Contact Name*Please upload club program logo*Please upload 2021 program flyer (If you have not yet produced a flyer please upload alternative information or logo again)Would you like to attend the 2022 football4all Gala Day (Date TBC)?*YesNoI need more informationWould you like to be involved in the football4all League in 2022?*YesNoTerms and Conditions All football4all programs operating within Football NSW must be approved by the local Football Association and by Football NSW. Program coordinators acknowledge that they have applied on behalf of the Club/Association of the program in which it intends to operate in. Affiliated football4all programs are required to ensure players in the program are registered on PlayFootball. Program coordinators ensure they provide Working With Children Check numbers of all volunteers in the program to their Club or Association Member Protection Officer. All other volunteers or coaches should be checked by the club to comply with the NSW State Government requirements. The WWC Check is a NSW State Government requirement which applies to people who work or volunteer with children (anyone under the age of 18). The program coordinator may use the football4all official logo and/or the Football NSW corporate logo on all printed material and on its website subject to receiving prior written approval by Football NSW (in accordance with FNSW brand guidelines). Program coordinators agree to have the above program information listed on the Football4all page of the Football NSW website.Terms & Conditions* I have read & agrees to the above terms and conditions Signature (please type above)* Δ