Player First Name
Players Last Name
Date of Birth:
Any injuries, allergies, disabilities, illnesses or relevant health concerns your coaches should know about?:
U7s - Mr Karl WellardU7s - Mr Richard KrzeminskiU8s - Mr Ross McDaidU8s - Mr Andy EvansU9s - Mr Lee PoppletonU10s - Mr Kris McdermottU10s - Mr Andy CroftU10s - Mr Paul WestonU11s - Mr Grant FlorenceU12s - Mr James ThirkillU12s - Mr Ian WhartonU13s - Mr Mick HawthornU13s - Mr Dave LeybourneU14s - Mr Neil CoatesU14s - Mr Marc PicklesU15s - Mr Chris AllenGirls - Mr Stuart ONeil
I confirm that I am the Parent or Legal Guardian of the player that I am registering with the club.
Date of Birth:
Yes, I agree to my son/daughter if injured whilst playing football or travelling to and from football Events to receive medical attention if I cannot be contacted on the above number, I hereby consent for my child to receive medical attention
In the Event That the Above Named Parent/Guardian Cannot be Reached, Please Give an Emergency Contact Name and Telephone Number
Yes, I agree to allow my child/children to be photographed/videoed during training or matches and for the club to use the images ( e.g. website) providing it is done in line with the FA guidelinesNo, I do not consent to my child /children being photographed or videoed - if selected you must tell the coach as soon as possible.
I give permission for the club to send me information from carefully selected organisations. I realise that the club will not pass on my details to any organisation and that I can withdraw this permission at any time by informing the club via an email to email@example.com.
The Eldwick Juniors committee, coaches and squad helpers can see, edit or use your membership data. We will use the data you provide to help us identify you and your child/children as members of the club and your squad and to send you information about club and squad matters. We do not see or hold any credit/debit card or bank details. If you are concerned or know about your data being used inappropriately please inform us immediately by telling a coach or emailing us on firstname.lastname@example.org. If we identify or are informed about a breach of data rules or our policies, we will get in touch with you and report it to the appropriate authorities within 72 hours.
I agree with the Terms & Conditions Click here to read Terms & Conditions.
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