REGISTRATION

Please fill out the form below and we will be in touch!

About Player

Player's Full name

Birthday

Day

Month

Year

Communication Needs (Does your child have any communication needs (e.g. non-English speaker/hearing impairment/sign language user/dyslexia?

Yes

If yes please state the communication needs

Current School

Parent/Guardian/Carer's Name

Parent Date of Birth

Day

Month

Year

Contact Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Emergency Contact

Medical History/Allergies/Food Intolerance

In case of emergency, I as the parent/carer of the player being registered herby authorise medical assistance to be given to my child by a qualified first aider if required and I am not available to assist

Yes

Emergency Contact (different to above)

Alternation Emergency Contact Number

Photographic Consent

I consent for the name young person to appear in photographs and film taken by the leaders throughout the football scheme, for use on website and social networks, publicity for future football schemes and for reporting.

I do NOT consent for the name young person to appear in photographs and film taken by the leaders throughout the football scheme, for use on website and social networks, publicity for future football schemes and for reporting.

Please tick the following:

I certify that the information given above is correct at the date of signing and understand that it is my responsibility to inform the coaches in writing of any changes.

I understand that this information will be held securely for contact purposes and use in emergencies.