£
HTJFC
Received cash/chq
PLAYER
REGISTRATION
TEAM NAME
2013 - 2014
Holy Trinity Juniors FC is an FA Charter Standard Club.
Hazlemere Sports Association Limited is a company limited by guarantee, company reg. no. 07270373, registered office: 20 Willow Chase, Hazlemere, High Wycombe, HP15 7QP
PLAYER DETAILS
Player’s Surname
Forenames(s)
Player’s Date of Birth
Home Telephone
Address and Post Code
If you/the family
attend Church
please state its
name and town
School Name and Town
School year from Sept
2013
Please state any medical details
for the player which we need to
be aware of, eg asthma
PARENT & EMERGENCY DETAILS
As parent(s) of a junior (Under 18) playing member, you automatically qualify for Family Membership of Hazlemere Sports Association
Limited (HSAL). This entitles you to enjoy the facilities at the new Ken Williams Memorial Pavilion at discounted rates. Your annual HSAL
membership fee is included in your annual subscription to Holy Trinity Juniors FC. A membership card will be issued to you following
receipt of this registration form.
Parent’s Surname
Emergency Contact
Number
Spouse’s / Partner’s
Surname
Mr/Mrs/Ms (delete, as appropriate)
Forenames(s)
Email
Mr/Mrs/Ms (delete, as appropriate)
Forenames(s)
In the event that the above named cannot be contacted, please give another two emergency contacts
Emergency
Contact Number
Emergency
Contact Number
Name
Name
FEES FOR THE SEASON – INCLUDES THE COST OF END OF SEASON BBQ
Under 5’s – U6’s £20,
Under 7’s – U8’s £50 ,
Under 9’s – U10’s £60 ,
Under 11’s – U16’s £70
Please note that for the Under 5’s - Under 6’s we require a parent/responsible adult be in attendance.
The above fees include your annual Family Membership of Hazlemere Sports Association Limited. You only need to pay this once so if you
have already paid it though another player at Holy Trinity please state the player’s name and team name below. Alternatively, if you have
already paid it through another Club (eg tennis, senior football) please state the name of the club and your membership number below.
Either way you should reduce the above fees by £10.
Player / Club : _________________________
Team / Membership no : ____________________
I enclose £ ________ as a membership fee to be repayable if this application is not successful.
I give my consent, in the event that my son/daughter is injured whilst playing football/training/travelling to and from football events
and I cannot be contacted on the above numbers, for my child to receive medical attention, to be transported to matches by their team
manager/ coach and any of the team helpers or other parents, to my son/daughter being photographed for the club’s own use.
I agree to be bound by and to observe the Club Rules and the Rules and Regulations of The Football Association Limited, the County
FA and all Competitions in which the Club participates. I also agree to reimburse the club for any fines incurred by my son/daughter.
It should be noted that by signing this form you are a member of HSAL and that you guarantee to contribute a sum not exceeding £1
to the Association’s assets in the event that HSAL is wound up and its assets are insufficient to meet its debts. Members shall be entitled
to attend and vote at General Meetings, which you will be notified of. Also by completing the above information, you consent to HTJFC
and HSAL holding your personal details on their membership databases.
Signed ____________________
Date ___________ Print name __________________
Please send this form and a cheque (payable to HTJFC) for the membership fee to:
Paul Baldock, 110 Roberts Ride, Hazlemere, Bucks, HP15 7AN