NOMINATE FOR MEMBERSHIP – Online
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    Enter your full street address

    Preferred playing Municipality

    Best Contact Number

    Please provide an Emergency CONTACT PERSON

    Please provide an Emergency CONTACT NUMBER

    Please select your age bracket
    - 4950 - 5960 - 6970 - 7980 +

    Have you played competitive Soccer before
    yes (a lot)yes (a little)not at all

    I have read and fully acknowledge the 'Agreement Of Understanding for Membership and Participation with Walking Football Tasmania Inc'

    I agrree to be sent a request for the $10 Annual Membership Fee and will make that payment within 1 week of request. I also acknowledge my Membership will be due for renewal the date after I join of the following year and (if renewing) will be paid within 7 days of expiry.

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    Agreement Of Understanding for Membership and Participation with Walking Football Tasmania Inc.

    Acknowledgement of risks, injury and obligations:
    I acknowledge that the activities I am to undertake may have potential issues for my wellbeing and by participating in them I am exposed to certain risks.

    I assume the risks of, and the responsibility for any injury, illness, loss of life or property resulting from participation in any activities.

    Release and indemnity to the Facilitators of Walking Football with Walking Football Tasmania Inc:
    In consideration of the acceptance of any payment (or guest status) for participating in any activity, I agree to release and indemnify Walking Football Tasmania Inc, Playing Group Facilitator(s) and any assitants, operator, its servants and agents as follows:

    • I participate in the activities at my sole risk and responsibility.
    • I release, indemnify and hold harmless Walking Football Tasmania Inc, Playing Group Facilitator(s) and any assitants, operator, its servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or other parties for or in respect of arising out of any injury, loss, damage or loss of life caused to me or my property whether by negligence, breach of contract or in any way whatsoever.

    I also agree that in the event that I am injured or my property is lost or damaged, I will bring no claim, legal or otherwise, against Walking Football Tasmania Inc, Playing Group Facilitator(s) and any assitants, operator or its servants, in respect of that injury, loss or damage.

    By selecting the checkbox I acknowledge I have read and understand all of the above and accept this Agreement.