Registration Form

OTTERY ST MARY YOUTH FC

 

Registration Form

Name -                  

                       

Address -                

                                                 

      

Post Code                           

Contact 1                 Contact 2

 Parent / Guardian Name -     

Telephone  - (Mobile)

Telephone – (Work)

Telephone – (Home)                          

E-mail Address -               

Parent / Guardian Mobile -

 

Child’s Date of Birth          -        

 

Text Box:  

 Text Box:    Gender (x)                 Male               Female                       

 

Known Medical Condition (s)  (Allergies/Asthma/Diabetes)   

 

School -                                           

 

Birth Certificate Number -                                             

 

Nationality -                            Religion -                       

 

Preferred Position -                    Previous Club -

 

Please sign below to confirm that:

You and your child have read and agreed to abide by the Ottery St Mary Youth FC Code of Conducts.

 

You agree to allow the first aider allocated to your team to administer first aid where permissible on your child.

 

You agree that photographs of your child are allowed to be shown on the clubs website and in local newspapers

 

__________________________                                      _____________

     Parent/Guardian - Signature                                         Date

 

      __________________________

      Print Name