Your Name *

Your Email *

Participant is under 18

If you are a parent/guardian completing this form on behalf of someone under 18, please answer the questions below. If not, please proceed to the next section.

Participants name

Participants date of birth

Parent/Guardian contact number

All participants - please complete

All participants are required to complete this section

Which team is the participant rostered to *

Use of media

Please agree, or disagree to the statements below. Once submitted, your choices can be changed by resubmitting the form again.

Photographs (still images) captured by league-appointed photographers/videographers *

Video footage captured by league-appointed videographers (including incidental audio) *

Use on league website and other public league communications *

Use on CSA public social media websites (e.g., Facebook, Instagram, X, TikTok) via CSA-managed accounts/pages *

Sharing within private team channels for coaching/team purposes (not for public reposting) *

Use in league promotional materials (e.g., flyers/posters) (may be public) *

Acknowledgements

I understand that I can withdraw consent at any time by contacting the Regulations & Governance Officer or Safeguarding Officer, and that withdrawal applies going forward. *

Acknowledged

I understand the league will take reasonable steps to remove content from leaguecontrolled channels if consent is withdrawn, but complete removal from third-party platforms may not always be possible. *

Acknowledged

I understand that safeguarding restrictions may override consent where necessary to protect a participant. *

Acknowledged

I confirm the information provided is accurate *

Acknowledged

Please verify that you are a human.