Player Dispensation Request – Clubs only – GWBA

Player's Name *

First

Last

Date of Birth *//

Parents/Guardians primary email *

Email

Confirm Email

Players parents must be included in correspondence for dispensation requests.

Club Name *

Competition played last year *

Exemption Request Type *

Competition should be playing *

Requesting to play *

Does the Club have a team entered in this players appropriate age group? *

Was this player approved for dispensation last year? *

Reason for seeking dispensation *

Information relating to this section may be shared with Member Clubs of Greater Western Baseball Association

Have this player played in a GWBA Representative Team *

Impact on Representative Opportunities *

I confirm that this request is made under the understanding that it is likely to disqualify the player from being considered for selection in any Representative Squads this season.

Form being submitted by: *

First

Last

Email *

Checkboxes *

I confirm that all the information provided is true and accurate. I also acknowledge that the assessment on the player's ability is initially the responsibility of our Club, and confirm that the requested dispensation is necessary for the protection of the player listed, and poses no abnormal risk to the players of the competition to which we are requesting the dispensation to play within.

Administration Fee

$ 0.00

Credit Card - using Stripe Payment Portal *

Card

Name on Card