Personal Information

First Name*

Surname*

Address*

Date of Birth*

Contact Number*

Email Address*

Occupation*

Polo Shirt Size*
SMLXLXXLXXXL

St Marys Rugby League Club Membership Number*

Club History

Are you a past/present member of St Marys Rugby League Club?*
YesNo

Please state number of year’s service with St Marys Rugby League Club:
Coaching:*

Playing:*

Other:

Managers Qualifications

Do you hold a current Managers Accreditation?*
YesNo

If yes, what is your PDJRL Registration Number?

Have you completed a current Working with Children Check?*
YesNo

Working with Children Check Number*

Expiry Date*

Team Nomination

Name the age team you would like to Manage:*
Age:

Division:

Do you have a child playing in this team?*
YesNo

Managers Roles and Responsibilities

I acknowledge that with my position as Team Manager I will be responsible for fulfilling the following commitments:
• Attend all Managers Meetings.
• Submit a game report for each and every game.
• Arrange for your team to participate in all organised team & club fundraisers.
• Record all team information in the Mangers Booklet provided.
• If playing away, return a copy of sign-on sheet (pink), to St Marys Rugby League Reception before the close of business Sunday.

By completing this form, I hereby acknowledge and I will abide by the St Marys Junior League Registration policy document which details the values of our club and what is expected.