REGISTRATION AND PAYMENT

MEMBERSHIP APPLICATION

To be completed by the Player or Parent/Carer

Please complete the details for the player:

First name

Last name

Age group:

Team name

Birthday

Day

Month

Year

Address

Phone number

School attended:

Doctors Name:

Doctors Telephone:

Doctors Address:

Emergency contact Name:

Emergency contact No.:

Has your child any Health/Medical Problems?

Yes

Details of Medical problems (Asthma, Allergies e.g. Penicillin, plasters etc)

If your child does have asthma please ensure they have their medication/inhaler with them at all times.

Does your child actively participate in religion or spiritual practice?

Parent's full name

Email (**IMPORTANT** to be used for club correspondence)

Signature

Signature field is empty.

Please select what you wish to pay for:

I wish to play for the team£45

I wish to attend training only£30

By submitting this form:

I/we hereby give permission for our/my son/daughter to join Torquespeed Football Club.

I/we give consent for our personal data to be used for club activities and to be passed to associated footballing

organisations in accordance with the Privacy Notice displayed on the club website, www.torquespeedfc.co.uk. It is noted

that individual player information will be stored on The Football Association’s player registration system which is

compliant with UK Data Protection legislation. You have a right to withdraw this consent at any time by written request.

I/we agree to photos of our/my son/daughter or the publication of his/her name to appear in regional newspaper articles,

www.torquespeedfc.co.uk and other Torquespeed Football Club promotional material.

I/we agree to ensure that our/my son/daughter is, by a responsible adult, handed over to and collected from a club coach at

the start and end of every training session, match or event. (parents/carers are encouraged to remain at all sessions).

I/we hereby agree to reimburse any fines imposed on Torquespeed Football Club for disciplinary action taken by Essex

County FA and/or other authorative bodies as a result of me/us our son/daughter being booked/cautioned/dismissed from

the field of play at any games which I/we our son/daughter attend/play in. As parents we agree to abide by the code of

conduct laid down by the club (which I/we have read and retained).

In the event of illness or accident requiring medical/hospital treatment, I/we authorise the team manager or appointed first

aider to administer emergency aid and/or seek medical attention.

All kit remains the property of the club and I/we agree to return all kit if I/we our son/daughter leaves the club.

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REGISTRATION AND PAYMENT

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