WASA Affiliation Form

For Affiliation to WASA please complete both the Club Information and Insurance Declaration parts of this form.

The names in Registrar and Race Secretary section will be given access to the Online Registration and Entry System. Ensure you have provided a valid email address and phone number.

If you do not contact our insurance broker and complete the required paperwork for the Management Liability Insurance, you will NOT have this cover. Certificate of Currency for the Public Liability insurance will be distributed once we have received your completed affiliation form, affiliation fee and we have received the certificate of currency from our broker.   

Please deposit the affiliation fee of $50 into our bank account:

Bank: CBA
A/C Name: Warringah Amateur Swimming Association
BSB: 062155
A/C: 28014943

 

Club Details

President Details

Secretary Details

Treasurer Details

Registrar Details

The Registrar will have access to the online registration and entry system, an email address is required

Race Secretary Details

The Race Secretary will have access to the online registration and entry system, an email address is required

Delegate Details

Insurance Information and Declaration

WASA provide the following insurance coverage for affiliated clubs and registered members:

• Personal Accident
• Legal Liability (Public Liability, $20m)
• Professional Indemnity (officials and coaches)
• Management Liability

The Personal Accident, Legal Liability and Professional Indemnity insurance is automatically obtained upon affiliation and registration of members with WASA. Management Liability (Directors Insurance) is obtained by contacting WASA’s insurance broker (AJG) directly. Our contact is Robert Dickinson, Robert.Dickinson@ajg.com.au. Three options are available:

• Do not obtain coverage
• Obtain coverage under WASA policy (WASA will be invoiced and will cover this cost)
• Obtain separate coverage (Club will be invoiced and Club will cover this cost)

 

Player Accident Claims

Are there any incidents that could lead to a claim that have not been reported to our insurance company?

Public Liability Cover

Professional Indemnity Cover

Are all Coaches/Referees/Instructors to be covered qualified?

Public Liability and Professional Indemnity Claims

Are there any incidents that could lead to a claim that have not been reported to our insurance company?

Declaration

For and on behalf of the Insured I represent that the above statements and facts are true and that no material facts have been suppressed or mis-stated.