Child Name *

***Due to limited places & coaches, only children that have been invited to register by a coach can be signed on. ***

First Name

Last Name

Parent/Guardian Name 1 *

First Name

Last Name

Parent/Guardian Name 2

If applicable

First Name

Last Name

Parent / Guardian Phone *

(###)

###

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Does your child have any health needs? (Diabetes, asthma, epilepsy, allergies etc) *

Yes

No

Does your child have any allergies? *

Yes

No

Does club need any medical training other than First Aid? *

If Yes, please specify

Yes

No

Does child have any access needs? *

If Yes, please specify

Yes

No

At times club may wish to take photos of teams or players. We adhere to FA guidelines to ensure there are safe and respectful and used solely for the purposes they are intended; which is promotion and celebration of the club. (Photos will not be identified with names if published in the media) *

Please indicate if this is acceptable to you

Yes

No

Parent/Guardian Consent *

By completing this form, I consent to my child participating in club events and agree to conditions outlined above. I confirm it is my responsibility to inform club to any changes to details recored in this form.

First Name

Last Name