Youth Club Championship Nomination Form "*" indicates required fields Step 1 of 4 25% Club InformationClub Name* Club Address*Club Contact Person* Contact Email* Contact Phone Number*Competition NominationWhich competition(s) is your club nominating for?* Youth Boys Club Championship Youth Girls Club Championship AffiliationDoes the club accept and adhere to Football West's terms of affiliation?* Yes No Upload proof of adherence to affiliation terms*Max. file size: 128 MB.SanctioningAre all teams, competitions, and programs sanctioned by Football West?* Yes No Provide details of sanctioned teams and programs*Upload documentation of sanctioning*Max. file size: 128 MB.Underpinning MiniRoos TeamsWhich of the following underpinning MiniRoos teams does the club have?*Please select all that apply Girls Boys None Miniroos - 2024 Retrospective Assessment How many Girls MiniRoos teams did the club have in 2024 for the following age groups?*Age GroupNumber of Teams Add Remove Add Remove Add Remove Add Remove Add RemoveHow many Boys MiniRoos teams did the club have in 2024 for the following age groups?*Age GroupNumber of Teams Add Remove Add Remove Add Remove Add Remove Add RemoveMiniroos - 2025 Planned TeamsWhich of the following MiniRoos teams does the club plan to have in 2025?*Please select all that apply Girls Boys None How many Girls MiniRoos teams does the club plan to have in 2025, for the following age groups?*Age GroupNumber of Teams Add Remove Add Remove Add Remove Add Remove Add RemoveHow many Boys MiniRoos teams does the club plan to have in 2025, for the following age groups?*Age GroupNumber of Teams Add Remove Add Remove Add Remove Add Remove Add RemoveDescribe the club's plan for expanding or maintaining MiniRoos teams in 2025*Upload any supporting documentation for 2025 plans(e.g., recruitment strategies, development programs)Max. file size: 128 MB. Technical DirectorName of Technical Director Does the Technical Director have a B-Diploma accreditation or higher? Yes No Upload a copy of the B-Diploma certificationMax. file size: 128 MB.How does the Technical Director plan to oversee player and coach development during the Championship?Upload any supporting documentation(e.g., development plans, strategies) Max. file size: 128 MB.Member Protection OfficerName of Member Protection Information Officer (MPIO) Has the MPIO completed the required training? Yes No Upload training certificate for MPIOMax. file size: 128 MB.How will the MPIO ensure the safety and well-being of participants during the Championship?Upload any supporting documentation(e.g., safety plans, policies)Max. file size: 128 MB.First AidName of First Aid Officer Is the First Aid Officer trained and qualified? Yes No Upload First Aid certificationMax. file size: 128 MB.Describe the club's first aid procedures and resources for the ChampionshipUpload any supporting documentation(e.g., first aid protocols, resources list)Max. file size: 128 MB.Club Changer StatusIs the club registered on the Club Changer Platform? Yes No What is the club's current status on the Club Changer Platform?3 star2 star1 starUpload evidence of Club Changer statusMax. file size: 128 MB.Describe the club’s initiatives that contributed to this statusUpload any supporting documentation(e.g., club initiatives, improvement plans)Max. file size: 128 MB. Additional Criteria Based on Competition Youth Boys Club Championship Specific Criteria 2024 Retrospective Assessment Did the club field teams in 2024 for the following age groups?* U13 U14 U15 U16 U13 League NPL Community Juniors U13 DivisionU14 League NPL Community Juniors U14 DivisionU15 League NPL Community Juniors U15 DivisionU16 League NPL Community Juniors U16 Division 2025 Criteria Does the club plan to field teams in each of the following age groups in the Junior Development League for 2025? U13 U14 U15 U16 Coach Qualifications For each team planned for 2025, list the coach’s name and current coaching accreditation level (e.g., C-Diploma, B-Diploma) U13 Coach Name U13 Coach - Current Accreditation Level C-Diploma B-Diploma Other U13 Coach - Upload proof of current accreditationMax. file size: 128 MB.If the U13 coach does not currently hold a C-Diploma or higher, please describe how the club intends to ensure they meet this requirement before the start of the 2025 seasonU14 Coach Name U14 Coach - Current Accreditation Level C-Diploma B-Diploma Other U14 Coach - Upload proof of current accreditationMax. file size: 128 MB.If the U14 coach does not currently hold a C-Diploma or higher, please describe how the club intends to ensure they meet this requirement before the start of the 2025 seasonU15 Coach Name U15 Coach - Current Accreditation Level C-Diploma B-Diploma Other U15 Coach - Upload proof of current accreditationMax. file size: 128 MB.If the U15 coach does not currently hold a C-Diploma or higher, please describe how the club intends to ensure they meet this requirement before the start of the 2025 seasonU16 Coach Name U16 Coach - Current Accreditation Level C-Diploma B-Diploma Other U16 Coach - Upload proof of current accreditationMax. file size: 128 MB.If the U16 coach does not currently hold a C-Diploma or higher, please describe how the club intends to ensure they meet this requirement before the start of the 2025 seasonDescribe how your club supports the development of these age groupsUpload any supporting documentationMax. file size: 128 MB.Youth Girls Club Championship Specific Criteria 2024 Retrospective Assessment Did the club field girls teams in 2024 for the following age groups? U14 U16 U14 League / Division U16 League / Division 2025 Criteria Does the club plan to field teams in each of the following age groups in the Junior Development League for 2025? U14 U16 Describe how your club supports the development of these age groupsUpload any supporting documentationMax. file size: 128 MB. Venue and Infrastructure Details Interest in Hosting as a Match Day HubWould your club like to express interest in using your venue as a match day hub for the Youth Club Championship? Yes No Please provide the followingVenue Name Venue Address Contact Person for Venue Coordination Contact Email Contact Phone Facility Details Pitch TypeGrassSyntheticHybridOtherIf other, please specify* Number of Full-Sized Pitches availableNumber of Mini Pitches availableSeating Capacity for SpectatorsParking CapacityChange Rooms and Amenities available? Yes No Describe the available change room facilitiesMedical Facilities or First Aid Room available? Yes No Describe the Medical Facilities / First Aid RoomPublic Transport accessible? Yes No Describe the Public Transport accessibilityCanteen or Catering Facilities available? Yes No Describe the Canteen or Catering FacilitiesLighting for Night Matches available? Yes No Describe the Lighting for Night MatchesUpload any supporting documentation or images of the venue and facilities Drop files here or Select files Max. file size: 128 MB. Venue Availability What dates will the venue be available from in 2025? Please pick a date rangeStart Date DD slash MM slash YYYY End Date DD slash MM slash YYYY Provide any additional information regarding availability or restrictions Additional Information Any other relevant information about the venue that would support its use as a match day hub AcknowledgmentPlease select below to acknowledge Acknowledgment that all information provided is accurate and complete Acknowledgment that the club agrees to abide by the rules and regulations of the Youth Club Championship SubmissionSubmitter's Name Submitter's Role/Position in Club