PLAYER DETAILS
Email:
Confirm Email:
Surname:
First Name:
Gender:
Male
Female
Age on 31 AUG 2011:
Date of Birth
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
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25
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27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Address 1:
Address 2:
Town/City:
Postcode:
Telephone:
Mobile:
Manager or Coach
MEDICAL INFORMATION
Doctor’s Name:
Surgery Name:
Doctor’s Address 1:
Doctor’s Address 2:
Town/City:
Postcode:
Medical Conditions:Please tell us about any existing medical conditions including any treatment and when it is used. Please also indicate if you feel football may have any impact on the condition.
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PARENT/CARER DETAILS
Email:
Confirm Email:
Surname:
First Name:
Relationship to player:
Address 1:
Address 2:
Town/City:
Postcode:
Telephone:
Mobile:
ALTERNATIVE CONTACT DETAILS
Email:
Confirm Email:
Surname:
First Name:
Relationship to player:
Address 1:
Address 2:
Town/City:
Postcode:
Telephone:
Mobile:
CODES OF CONDUCT AND TERMS & CONDITIONS
By submitting this registration form I hereby apply for membership of Larkhall Athletic, on behalf of the child named above, and agree to pay the membership subscription as listed on our website in the Membership Fee policy 2011/12. If the child is accepted for membership, I also understand and agree that:
Coaches will arrange any necessary first aid and emergency treatment in the unlikely event of it being required
My child is subject to, and must abide by the club policies and procedures, as well as myself and any person associated with the player attending matches. Our policies are available on the club website
Membership subscriptions are not refundable in the event of players leaving the club during the season, except in exceptional circumstances as decided by the executive committee
By submitting this form I also agree that the parent/carer has read and understood the FA Respect Guide for Parent/Carers and Spectators. I also confirm the registering player has read and agrees to the terms of the FA Respect Guide for players. Larkhall Athletic also agrees to the terms in the Respect and Clubs with Youth Teams Guide, available on the FA.com Respect webpage.
PERMISSIONS AND VOLUNTEERING
Like nearly all youth football clubs, Larkhall Athletic relies on volunteers to administer, coach and manage our teams. As well as this we also rely on parents to referee, run the line and help with recruitment, website administration, general administration and our financial responsibilities.
If you are able to help out in any way please tick the relevant boxes. Alternatively if you are not sure and would like some advice or information please contact the team’s manager/coach or the Chairman, Vice Chairman or Child Welfare Officer via the contact us link on the website.
