Surridge Gloucestershire County Football League
GLOUCESTERSHIRECOUNTY FOOTBALL LEAGUE
CLUB APPLICATION FORM & GROUND GRADING INSPECTION
QUESTIONNAIRE (Step 7)
Name of Club–(Mandatory)Gloucestershire Football Association Affiliations Number -
Current League–
Name of Ground–
Address including Post Code -
Has your Club achieved Charter Standard Status / Yes / No
1. SECURITY of TENURE Delete Yes or No
Who owns the ground?
Please give details of length of agreement if your Club are Tenants:
Is the club under any obligation, written or verbal, to any other organisation by which it does not have sole control of its Management Finances or players? / Yes / No
2. GROUND SHARE
Does your Club Ground Share with another Football Club
IF YES - NAME OF CLUB AND LEAGUE / Yes / No
3. SHARED FACILITIES
Does you Club share their facilities with a Cricket Club or any other organisation / Yes / No
4.BOUNDARY OF GROUND
Is the ground fully enclosed by a permanent boundary of the appropriate construction? - / Yes / No
Is it possible to view a match from any point outside the ground? / Yes / No
If YES, please give details –
The maximum distance allowed from the pitch to the dressing rooms is
65 metres - Please state distance
Has the club got exclusive use of the ground? / Yes / No
If NO please give details.-
Has the ground got good accessibility from the road? / Yes / No
5. CLUBHOUSE
Is there a clubhouse open to spectators on match days? / Yes / No
6. CAR PARKING
Are there adequate car parking facilities on or adjacent to the ground?
Please state number of spaces?
7.PITCH PERIMETER BARRIER
Is there a pitch perimeter barrier on all four sides 1.1 metres high / Yes / No
Is there at least 1.83 metres between the barrier and the goal/touchlines / Yes / No
8.PITCH STANDARDS
Dimensions (minimum 100 x 64 metres) Please give size in Metres
Is the pitch natural grass? / Yes / No
If there a significant slope, please indicate the gradient
Do the goalpost reach the required safety standards set out by the Football Foundation – / Yes / No
9.TECHNICAL AREA
Are the trainers’ boxes:-FIXED or PORTABLE (Please Delete)
Are they Equidistant from the halfway line? / Yes / No
How many adults can be accommodated in each on fixed seating(Number)
Is their a marked Technical Area / Yes / No
10.SECURE WALKWAY
How far is the entry point to the pitch from the door to the dressing rooms
(In Metres please)
Please describe the structure which ensures the safe passage of players and officials en route. (If erected)
11. FLOODLIGHTING
Please state whether the Club has Floodlights / Yes / No
If Yes please give Readings
Average lux reading Maximum lux reading Minimum lux reading
12. PUBLIC ADDRESS SYSTEM
Is there a PA system audible in all areas which can be occupied by spectators / Yes / No
13.ENTRY
Has the Club a pay boxes or turnstiles / Yes / No
Can admission be charged? / Yes / No
Does the club produce a Match-day Programme? / Yes / No
14.EXITS
How many exit gates if ground is enclosed (Number)
15.ADJOINING PITCHES
Are there any adjoining pitches? / Yes / No
If YES, please give details. Number and type of pitches:-
Distance from the pitch that the Club is using Metres
16.SPECTATOR ACCOMMODATION
Hard Standing
Is there any hard standing (minimum width 0.9 metres) around the perimeter of the pitch? Please give details (Number of Sides) / Yes / No
Seating Accommodation
Please give the number of covered seats? (If none please state)
Covered Standing Accommodation
Please give the number of covered standing places? (If none please state)
17.SPECTATOR TOILETS
Please give number of:-
(a) Urinals
(b) WCs for men
(c) WCs for women
(d) Wash hand basins for men
(e) Wash hand basins for women
Are warm air hand driers and/or paper towels provided? / Yes / No
18. REFRESHMENT FACILITIES
Is there a refreshment outlet for spectators (Tea / Coffee and food) / Yes / No
19. DISABLED FACILITIES
The club must be able to accommodate disabled spectators in accordance with the requirements of the Disability Discrimination Act 1995.
Reference should be made to the Information/Data Sheets by both The Football Association and the Football Foundation..
20.DRESSING ROOM FACILITIES
Home Team
Size of changing area (excluding washing/toilet area) square metres
Number of showerheads (min. 4)
Number of urinals
Number of WCs
Number of wash hand basins
Is there a treatment table? / Yes / No
Away Team
Size of changing area (excluding washing/toilet area) square metres
Number of showerheads (min. 4)
Number of urinals
Number of WCs
Number of wash hand basins
Is there a treatment table? / Yes / No
Match Officials
Size of changing area (excluding washing / toilet area) square metres
Number of showerheads (min.1)
Is there a WC / Yes / No
Is there a wash hand basin / Yrs / No
Additional Accommodation for Female Match Officials
Are there additional changing, washing and toilet facilities available for mixed sex referee teams? / Yes / No
21. MEDICAL
Does the Club have:-
1. Adequate First Aid equipment: / Yes / No
2. Treatment Couch / Yes / No
3. Stretcher / Yes / No
4. Does the Club have a fully trained first aid in attendance on match days?
Certificate Required / Yes / No
5. Adequate means of contacting the emergency services? / Yes / No
6. Is there accesses for an Ambulance to reach the pitch? / Yes / No
22. GENERAL
Do you comply with legislation in respect of:-
1. Insurance other than the Compulsory Public Liability? / Yes / No
2. Fire Certificate for PublicBuilding? / Yes / No
3. Current certificate to cover the Electrical Installation of the Building (NIC EIC)? / Yes / No
4. Does the Changing Facilities comply with all Local Statuary Bodies Regulations? / Yes / No
Club Information
1.How many volunteers make up the Management Committee of your Club and what post do they hold.
Name
Chairman
Secretary
Treasurer
Other Management
- How many senior teams do you support? How many volunteers are involved with each team?
- Have you any links too - or have a youth team organisation within your Club. How many volunteers are involved with each team? Please explain set up.
4.Is the Club prepared if the manager resigns and there is a mass exodus of players? What steps would your Club take?
The following documents must be submitted with this application form. Failure to send any of the documents required will render your application invalid.
1) Copy of the Club Constitution.
2) Copy oflatest Accounts & Balance Sheet for the Club, as submitted to
most recent Annual General Meeting.
3) Copy of at least one statement of Club Bank Account as officially issued by your Bank.
4) Evidence that your Club has written permission to play at your ground.
5) Acheque for £60(Not refundable) - Inspection Fee made payable to Gloucestershire County Football Leaguemust accompany all applications failure to send fee will render application invalid.- Further Inspections will incur a £40 fee
6) Copy of valid Certificate of any person(s) who has passed the First Aid stage 1
Signed By Club Secretary:
Print Name:
Contact Home number
Contact Mobile number
Email Address
PLEASE RETURN THIS FORM BY POST
POSTAL ADDRESS – Ron Holpin 27, Brockley Close, Little Stoke, Bristol. BS34 6HA
PLEASE ALSO ENSURE THAT A COPY OF THE COMPLETED QUESTIONNAIRE IS FORWARDED TO YOUR CURRENT LEAGUE SECRETARY.
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