2022 BASL Dispensation Form

1

Club Name* This field is required.

2

Club Contact Details* This field is required.

Contact Name

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Please enter your email

Club Role (i.e. President, Secretary, Junior Co-Ordinator)

3

Player Details* This field is required.

Player Name

Date of Birth

FFA Number

4

Competition Seeking Dispensation

BASL Seniors

BASL Juniors (Competitive) - Mixed

BASL Juniors (Competitive) - Girls

BASL Non-Competitive

5

Does your club have a team within the players correct age group?* This field is required.

YESNO

6

Is the agreement for seniors attached to this application?

YESNO

7

Is the medical information required attached? (Where applicable)

YESNO

8

Additional InformationPlease provide any additional information in the space below

9

File UploadEnsure any necessary attachments are provided here.

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Select files to upload

Max. file size: 10.6MB

10

Note: Players seeking a dispensation (where required) must NOT play in any competition outside the Rules of Competition until approval in writing has been received from BASL.

11

Thank you for your submission. BASL will provide a answer after the review of information provided.