Covid-19 Postponement Request Form

Club Name(Required)

League(Required)

Division(Required)

Division(Required)

Division(Required)

Division(Required)

Division(Required)

Team(Required)

Age Group(Required)

Age Group(Required)

Opposition Team Name(Required)

Host Team & Venue Name(Required)

Match Date(Required)

KO Time(Required)

:

Reason for requesting postponement(Required)

Number of Players Unavailable due to COVID-19(Required)

List Players Unavailable (If more than 5 use the large box below)(Required)

Player Name(Required)

Position(Required)

Reason for Unavailability(Required)

Player Name(Required)

Position(Required)

Reason for Unavailability(Required)

Player Name(Required)

Position(Required)

Reason for Unavailability(Required)

Player Name(Required)

Position(Required)

Reason for Unavailability(Required)

Player Name(Required)

Position(Required)

Reason for Unavailability(Required)

Please provide supporting information on player availability(Required)

Please provide as much detail as possible

Please provide details on coach availability(Required)

Please provide as much detail as possible

Please provide details on your venue capacity / venue requirements(Required)

Please provide as much detail as possible

Will you be switching venues with the opposition (away) team(Required)

If Yes, what is the venue name(Required)

New Date(Required)

New KO Time(Required)

:

If No, please explain why(Required)

Please provide as much detail as possible

Proposed Date 1(Required)

Football West will use these dates to liaise with the impacted Clubs around rescheduling the match.

Proposed Date 2(Required)

Football West will use these dates to liaise with the impacted Clubs around rescheduling the match.

Proposed Date 3(Required)

Football West will use these dates to liaise with the impacted Clubs around rescheduling the match.

Please attach any Supporting Documentation

Max. file size: 128 MB.

Club Contact Name(Required)

First Last

Position at Club(Required)

Phone(Required)

Email(Required)

File

Max. file size: 128 MB.

File

Max. file size: 128 MB.

File

Max. file size: 128 MB.

File

Max. file size: 128 MB.