Covid-19 Postponement Request Form Club Name(Required) League(Required)NPLMNPLWJunior NPLState League MState League WAmateur League MAmateur League WMetro League MenMetro League WomenMasters League MenJunior BoysJunior GirlsDivision(Required)First Team20s18s16s15s14s13sDivision(Required)First Team21sDivision(Required)First TeamReserves18sDivision(Required)PremierDivision 1 – 4Division(Required)Premier12345Team(Required)First TeamReservesAge Group(Required)13s14s15s16sAge Group(Required)13s14s15s16s17s18sOpposition Team Name(Required) Host Team & Venue Name(Required) Match Date(Required) MM slash DD slash YYYY KO Time(Required) Hours : Minutes AM PM AM/PM Reason for requesting postponement(Required)Player AvailabilityNumber 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)GoalkeeperRight Full-backLeft Full-backCenter-backDefensive MidfielderRight MidfielderCenter MidfielderStrikerAttacking MidfielderLeft MidfielderReason for Unavailability(Required)Covid PositiveClose ContactOtherPlayer Name(Required) Position(Required)GoalkeeperRight Full-backLeft Full-backCenter-backDefensive MidfielderRight MidfielderCenter MidfielderStrikerAttacking MidfielderLeft MidfielderReason for Unavailability(Required)Covid PositiveClose ContactOtherPlayer Name(Required) Position(Required)GoalkeeperRight Full-backLeft Full-backCenter-backDefensive MidfielderRight MidfielderCenter MidfielderStrikerAttacking MidfielderLeft MidfielderReason for Unavailability(Required)Covid PositiveClose ContactOtherPlayer Name(Required) Position(Required)GoalkeeperRight Full-backLeft Full-backCenter-backDefensive MidfielderRight MidfielderCenter MidfielderStrikerAttacking MidfielderLeft MidfielderReason for Unavailability(Required)Covid PositiveClose ContactOtherPlayer Name(Required) Position(Required)GoalkeeperRight Full-backLeft Full-backCenter-backDefensive MidfielderRight MidfielderCenter MidfielderStrikerAttacking MidfielderLeft MidfielderReason for Unavailability(Required)Covid PositiveClose ContactOtherPlease provide supporting information on player availability(Required)Please provide as much detail as possiblePlease provide details on coach availability(Required)Please provide as much detail as possiblePlease provide details on your venue capacity / venue requirements(Required)Please provide as much detail as possibleWill you be switching venues with the opposition (away) team(Required)YesNoIf Yes, what is the venue name(Required) New Date(Required) MM slash DD slash YYYY New KO Time(Required) Hours : Minutes AM PM AM/PM If No, please explain why(Required)Please provide as much detail as possibleProposed Date 1(Required) MM slash DD slash YYYY Football West will use these dates to liaise with the impacted Clubs around rescheduling the match.Proposed Date 2(Required) MM slash DD slash YYYY Football West will use these dates to liaise with the impacted Clubs around rescheduling the match.Proposed Date 3(Required) MM slash DD slash YYYY Football West will use these dates to liaise with the impacted Clubs around rescheduling the match.Please attach any Supporting DocumentationMax. file size: 128 MB.Club Contact Name(Required) First Last Position at Club(Required) Phone(Required)Email(Required) FileMax. file size: 128 MB.FileMax. file size: 128 MB.FileMax. file size: 128 MB.FileMax. file size: 128 MB.Acknowledgement(Required) I agreeBy ticking this box I acknowledge that the information I have provided on behalf of my Club is accurate and agree that if the information I have provided is incorrect that my Club may face repercussions that may include fines, loss of competition points or disaffiliation from Football West. Under the terms of the Football West Code of Conduct I may also be personally found liable if the information is found to be inaccurate.