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As School Principal, I hereby apply for Brooklyn Park Ptimary School to be admitted as a member of the North West Junior Soccer Association Inc. (NWJSA) for the season.

I Will:

Do all that is reasonable to ensure the School, its officers, players and volunteers will at all times abide by the constitution, rules and regulations of the NWJSA.

Acknowledge NWJSA Regulation 4.1 stipulation that the school player registration form will include a Player, Parent and Spectator commitment to comply with NWJSA Codes of Conduct.

Acknowledge that a requirement of participation with NWJSA is a Player Death and Disability insurance cover of $100,000. If the School does not provide this level of insurance, the School will obtain this insurance via the options offered by NWJSA.

Endorse and agree to abide by the NWJSA Member Protection Policy (MPP) and endorse the Child Safe Environment Compliance Statement lodged by the NWJSA with the South Australian Department of Education and Child Development.

Agree to implement and adhere to the steps outlined in the (MPP) document to ensure that my School is compliant.

Principal Name

Vicky Jones

Principal E-mail

victoria.jones909@schools.sa.edu.au

Appointment of Delegate

As Principal, I hereby appoint the following person to act as Delegate in all matters connected with the School and the NWJSA. I acknowledge that if a Delegate is not appointed, I will act as Delegate until such time that another person is appointed. I understand that it is the responsibility of the appointed School Delegate to attend NWJSA meetings and forward information from NWJSA to the school, coaches, parents and players. Also, I acknowledge that the appointed School Delegate will represent the School and vote on behalf of the School at General Meetings of the NWJSA.

Delegate Mobile Number

0439998774

Delegate Name

Mel Phillips

Delegate E-mail

mel.phillips456@schools.sa.edu.au

Delegate Signature