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 Charlotte Ercil on (02) 8814 4459 or email charlottee@footballnsw.com.au
Official Name of football4all Program*
Football Club in Which the Program Operates*
Association in which the Club program operates*
Approval 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?*
What time does the program run?*

: HH

MM
What time does the program end?*

: HH

MM
Program Location*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Age Grade*
Cost*
Example: $10/session, $50 Registration, Free
Club 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 program
Abilities welcome to participate in the program*
If other, please specify
Club Member Protection Information Officer (MPIO) Contact Name*
Please upload club program logo*
Please upload 2019 program flyer (If you have not yet produced a flyer please upload alternative information or logo again)
Would you like to attend the 2021 football4all Gala Day (Sunday 27th June 2021)?*
Would you like to be involved in the football4all League in 2021?*
Terms 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)*