NSW ABORIGINAL RUGBY LEAGUE KNOCKOUT 2017 NOMINATION FORM Instructions to Nominee Clubs Your participation 1
Your team s participation in the 2017 NSW Aboriginal Rugby League Knockout (the Event) is conditional on your completing and submitting this nomination pack by Monday 25th September 2017 (Nomination Deadline) and is also conditional on your compliance with the terms and conditions set out in this nomination pack. If you do not submit your nomination by the Nomination Deadline, or if you submit an incomplete nomination, your team or individual members of your team may be excluded from the Event. Please read these documents carefully. Checklist Please do the following: 1. Carefully read and ensure that you understand the terms and conditions set out in this nomination pack which govern your participation in the Event, including: the NSW Aboriginal Rugby League Knockout Rules and Regulations; and the NRL National Code of Conduct. Failure to comply with the terms and conditions may result in the exclusion of your team or individual members of your team from the Event. 2. Complete, sign and date the following forms which are attached to this nomination form: Form A Club Nomination; Form B Team Details and Declaration; Form C Aboriginality Declaration; Form D Film and Photography Permission; Form E Declaration of Consent (if applicable). 3. Arrange payment of the non-refundable nomination fee of $[1,500] for each team men s and women s teams you are nominating. Nominations for participation in the Under 12s, Under 15s and Under 17s competitions are free. Payment of the nomination fee can be made as follows: Bank cheque made out to Redfern All Blacks Rugby League Football Club Incorporated and attached to the completed nomination form; or Direct deposit to the following bank account with the subject line Knockout. Direct deposit receipts must be emailed to rabkofooty@gmail.com, with the subject line Knockout nomination [your club name] before the nomination form will be accepted: Account Name: REDFERN ALL BLACKS INCORPORATED KNOCKOUT BSB: 062231 Account No: 10444532 RAB KO 2017 NOMINATION FORM 2
4. Return the completed forms and payment to: PO Box 669, STRAWBERRY HILLS NSW 2012 or rabkofooty@gmail.com 5. If there are any changes to the team list provided in Form B Team Details and Declaration after you have submitted your nomination, including at any time during the Event: notify the organiser as soon as reasonably practicable via email to rabkofooty@gmail.com; and ensure that each new player signs Form B Team Details and Declaration or, if the new player is under 17 years of age, their parent/guardian signs Form E Declaration of Consent Form, and return the completed forms to rabkofooty@gmail.com. Please note that individuals will not be permitted to participate in the Event until the above forms have been received. If you have any questions regarding anything in this nomination pack, please contact Redfern All Blacks on rabkofooty@gmail.com RAB KO 2017 NOMINATION FORM 3
Knockout Weekend Information The Redfern All Blacks Rugby League Football Club will host the 2017 NSW Aboriginal Rugby League Knockout (Event). The Event will be held from Friday 29 September to Monday 2 October 2017 at Leichhardt Oval, Leichhardt Oval 2 and Glover Street Oval, Lilyfield. A fourth oval may be used on Friday. Please check for further updates on the Redfern All Blacks website, the Redfern All Blacks Facebook page and in the Koori Mail newspaper. Official Draw The Redfern All Blacks Rugby League Football Club will conduct the official draw: Date: 27 th September 2017 Time: 6.30pm 11.30pm Venue: TBC. Each registered club will be invited to nominate two delegates to attend the 2017 Knockout Official Draw as guests of the Redfern All Blacks Rugby League Football Club. More information and additional tickets for the 2017 Official Knockout Draw will be available. Further information will be updated via the Redfern All Blacks website, Facebook and Koori Mail. Tickets Tickets to each days play during the Event will be available for purchase at the main entry to Leichhardt Oval and the Glover Street entrance. If a fourth oval is used a ticket booth will be located near by on Friday, only. Prices: Adults: $10 per day (Friday, Saturday and Sunday) $5 Monday Single adult weekend passes: $30 Children 15 and under & Aged Pensioners: Free Admission Proof of age photo ID will be required (such as School, Football, Library or Seniors Card). Team weekend pass (30 passes): $800. Please purchase prior to the weekend. Team passes must be collected at the ticket box at the Leichhardt Oval entry gate. RAB KO 2017 NOMINATION FORM 4
Prize Money Allocation 2017 Men s competition WINNER: RUNNER UP: 3rd and 4th: $[1,000] of total nomination multiplied by number of teams entered $[250] of total nomination multiplied by number of teams entered $[125] of total nomination multiplied by number of teams entered Women s competition WINNER: RUNNER UP: 3rd and 4th: $[1,000] of total nomination multiplied by number of teams entered $[250] of total nomination multiplied by number of teams entered $[125] of total nomination multiplied by number of teams entered All prize money will be paid to the Chairperson or the Team Committee Representatives whose name and signatures appears on Form A Club Nomination. All teams must nominate a bank account for the monies to be paid into. RAB will not deal with cash payments over the weekend. Please be advised that all clubs eligible for the nomination fee reimbursement will be paid by cheque or direct deposit into the bank account nominated on the form. Please indicate if you would prefer a bank cheque or the monies to be deposited into a bank account. Please tick a box and provide details: BANK CHEQUE DIRECT DEPOSIT ACCOUNT NAME:.. BSB:.. ACCOUNT NUMBER:..,,,,,,,,,,,,,. Program Friday 29 September Women s, U12s, U15s & U17s Competitions Commencing: Estimated completion: 8.00am 8.00pm Saturday 30 October Men s Competition Commencing: Estimated completion: 8.00am 7.00pm RAB KO 2017 NOMINATION FORM 5
Sunday 1 October Men s Competition (Daylight savings begins) Commencing: Estimated completion: 8.00am 6.00pm Monday 2 October Finals: U12s, U15s, 17s, Women s & Men s Competitions Commencing: Estimated completion: 8am 5pm Teams Capped: Teams will be capped this year. Redfern All Blacks will not be in a position to allow additional teams once the cap has been reached. In the Women s and Children s Competitions, we ask that you do not submit two teams from the one club. This decision has been made to ensure that more teams from a number of clubs and locations are able to participate. Numbers of teams Men s: 64 teams Women s: 16 teams 17 s: 16 teams 15 s: 16 teams 12 s: 16 teams Please be aware that there will be no exceptions after the capped amount has been reached. Teams will not be accepted into the draw until all of their nomination form has been completed. For the Men s and Women s Competition the forms must be fully completed and the nomination fee must be paid in full. If the form is not fully completed and the fee not paid, the nomination will not be accepted. Only teams, which have completed both processes, will be included in the draw. Redfern All Blacks understands that teams do not always know their total playing roster/team list prior to the week of the Knockout. As per s17 of the Rules and Regulations, you may list players on your nomination form, however, this team may change prior to the Knockout weekend. The final team must be listed and submitted to the official table 30 minutes prior to the first game. After you have submitted your team list prior to the first game the team list cannot be changed. All players must sign in the same column and wear the same number for the duration of the Knockout carnival. If you have any queries, please advise. We would prefer teams be clear on the Rules and Regulations then risk disqualification. RAB KO 2017 NOMINATION FORM 6
Club Nomination (Form A) (i) Club Name: (ii) (iii) (iv) (v) (vi) Club Postal Address: Phone number: Mobile number: Email: A.B.N.: Please tick competition nominating for: Men s Women s Under 12 s Under 15 s Under 17 s Please use one form for each team Committee Representatives Position: (vii) (viii) (ix) (x) (xi) (xii) Name: Chairperson: Committee Member: Coach: Team Manager: Team Delegate: Declaration (to be completed by authorised club representative) I declare, as an authorised representative of the above named club, that we will abide by the NSW Aboriginal Rugby League Knockout Rules and Regulations and the NRL National Code of Conduct that govern our participation in the Event. I acknowledge that a failure to comply with the Rules and Regulations and Code of Conduct may result in our disqualification from the Event. NAME... SIGNATURE... DATE... /... / RAB KO 2017 NOMINATION FORM 7
Team Details and Declaration (Form B) TEAM NAME If registering two (2) teams, please indicate which team First Second Declaration and Disclaimer (to be completed by all club participants) I represent the above named club and declare, as a condition of my participation in the 2017 NSW Aboriginal Rugby League Knockout that: 1. I have not registered with any other club that is or is likely to be participating in the Event; 2. I am aware of the inherent risks involved with participating in rugby league and I knowingly assume those risks. I hereby release and indemnify the Redfern All Blacks Rugby League Football Club and any other governing body from and against all claims, losses and liabilities for personal injury (including death) and loss or damage to personal property arising out of or in connection with my participation in the Event. 3. I have informed all players of the above clause aware of this clause. 4. I will at all times during the Event abide by the NSW Aboriginal Rugby League Knockout Rules and Regulations and the NRL Code of Conduct, copies of which have been provided to me. Team Coach Team Manager Please Print Name Please Print Name Signature Signature RAB KO 2017 NOMINATION FORM 8
Team Players No. Name (please print) D.O.B. Signature 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 RAB KO 2017 NOMINATION FORM 9
Aboriginality Declaration (Form C) CLUB OFFICIAL:... (PLEASE PRINT NAME AND POSITION IN BLOCK LETTERS) CLUB NAME:... (PLEASE PRINT CLUB NAME IN BLOCK LETTERS) I declare that all players listed on Form B - Team Details and Declaration to participate in the 2017 NSW Aboriginal Rugby League Knockout with this club are of Aboriginal and/or Torres Strait Islander descent. SIGNATURE:... Please note that new players are required to provide a completed Confirmation of Aboriginality before they can be registered to play in the Knockout, with the stamp of the Common Seal of the organisation that is providing the confirmation. Committee representatives listed above who are found to knowingly include players in their team entry to the 2017 NSW Aboriginal Rugby League Knockout who are not Aboriginal and/or Torres Strait Islander will be subject to strict penalties. Those officials will be suspended from participating in future NSW Aboriginal Rugby League Knockout tournaments for a period of not less than five (5) years. Disputes involving proof of Aboriginality will be dealt with by the Review Committee and where necessary, referred to the Indigenous Rugby League Council (see S 47 Rules and Regulations Redfern All Blacks 2017 Knockout). RAB KO 2017 NOMINATION FORM 10
Film and Photography Permission (Form D) EVENT NAME: Koori Knockout 2017 GROUP NAME or PARTICIPANT NAMES: GROUP REPRESENTATIVE NAME: CONTACT ADDRESS: PHONE: 1. By this Deed, I, the Group Representative, grant to Redfern All Blacks Rugby League Football Club Incorporated (the Organiser), the right to: a. make audio and/or visual recordings of the group/participants including any performance by the group/participants and their copyright material (Recordings); and b. use the Recordings (or any part of it) in all media throughout the world in perpetuity, including broadcast by television, website and to promote the Organiser or its licensees; and c. authorise and license other parties to make and use the Recordings as described above. 2. I confirm that I am authorised to grant, and there are no restrictions, which prevent me from granting, these rights, including the use of the group name and/or participant names in association with the Recordings. If any group members are under the age of 18 years, I confirm that the group members parents or legal guardians have consented. 3. I acknowledge that the Organiser or its licensees will own all rights, including copyright, in the Recordings and the right to sublicense these rights. 4. I also agree to provide notice to the Organiser if there is any copyright material in my performance that is not owned by me. 5. I agree that, where the group s contribution to the Recordings includes Indigenous Cultural and Intellectual Property (such as traditional stories, songs, dances, artistic works and knowledge) we have authority from the traditional owners to use the Indigenous Cultural and Intellectual Property for the purposes described in this release. 6. I agree to use reasonable endeavours to provide the Organiser or its licensee with information regarding any passing on protocols that may apply in regard to the performers. EXECUTED AS A DEED: Signed by the Group Representative in the presence of: Participant s Signature Witness Signature Date Signed for and on behalf of the Organiser in the presence of: Representative s Signature Witness Signature Date RAB KO 2017 NOMINATION FORM 11
Declaration of Consent (Form E) TO BE COMPLETED BY PARENTS OR GUARDIANS OF PARTICIPANTS UNDER THE AGE OF SEVENTEEN (17) YEARS AS A CONDITION OF PARTICIPATION IN THE 2017 NSW ABORIGINAL RUGBY LEAGUE KNOCKOUT. I,... (Please print Parent/ Guardian name) OF... (Please print address) HEREBY GIVE CONSENT FOR: 1:...... (Print Name) (Signature of player) to participate in the 2017 NSW Aboriginal Rugby League Knockout to be held at Leichhardt Oval, Leichhardt Oval 2 and Glover Street Oval, Lilyfield. I declare and agree, as a condition of the participant named above participating in the Event, that: 1. he/she is not registered with any other club that is or is likely to be participating in the Event; 2. I am aware of the inherent risks involved with playing rugby league and I knowingly assume those risks on behalf of him/her. I hereby release and indemnify the Redfern All Blacks Rugby League Football Club and any other governing body from and against all claims, losses and liabilities for personal injury (including death) and loss or damage to personal property arising out of or in connection with his/her participation in the Event. 3. he/she will at all times during the Event abide by the NSW Aboriginal Rugby League Knockout Rules and Regulations and the NRL Code of Conduct, copies of which have been provided to me. SIGNED:... DATE:... (Parent/ Guardian Signature) WITNESS:... DATE:... (Print Name)... (Signature) NOTE: A separate form is required for each child under the age of seventeen (17 RAB KO 2017 NOMINATION FORM 12
Nomination Acceptance (host club use only): HOST CLUB ENDORSEMENT DETAILS NOMINATED TEAM:... COMPETITION NOMINATED FOR: Men s Women s Under 12 s Under 15 s Under 17 s COMPLETED FORM RECEIVED: CLUB NOMINATION (FORM A) TEAM DETAILS AND DECLARATION (FORM B) ABORIGINALITY DECLARATION (FORM C) FILM AND PHOTOGRAPHY PERMISSION (FORM D) DECLARATION OF CONSENT (FORM E) PAYMENT RECEIVED: BANK CHEQUE DIRECT DEPOSIT DATE PAYMENT RECEIVED:... /... /... NOMINATION ACCEPTED:... (NAME) SIGNATURE:... DATE:... /... /... RAB KO 2017 NOMINATION FORM 13