FAN NUMBER
SEASON
2016 - 2017
U13 – U18 CLUB REGISTRATION & MEDICAL DETAIL FORM
WEST EXE YFC
CLUB
FORENAME:
AGE GROUP & TEAM NAME
SURNAME:
DATE OF BIRTH:
ADDRESS:
POST CODE:
TEL. & EMERGENCY
CONTACT DETAILS:
(NAME & NUMBER)
SCHOOL:
DOCTOR NAME:
EMAIL:
1.
2.
3.
4.
OTHER TEAMS PLAYING
FOR IN CURRENT SEASON:
SURGERY
TEL:
Do you consider your child to be fit and capable of taking part in all activities expected of football training and competitive matches?
Y/N
Does your child suffer from any allergies or health problems that require medication. If yes please list the following details below:- NAME
OF MEDICATION / DOSAGE / TIME TAKEN / REASON FOR TAKING
Y/N
Has your child ever suffered a serious injury which needs to be brought to the Clubs attention i.e broken leg / arm etc. If yes please give
details:-
Y/N
In case of a serious accident, or illness, do you give permission for us to act in loco parentis. IF WE ARE UNABLE TO CONTACT YOU.
i.e taking your child to hospital and giving permission for treatment.
Y/N
DATE OF LAST TETNUS:
PERMISSION FOR DETAILS TO BE USED ON CLUB WEBSITE, IN PAPERS, OR CLUB
PUBLICATIONS:
PHOTOGRAPH – YES / NO
NAME YES
/
NO
ALL ABOVE SECTIONS MUST BE COMPLETED
WE CONFIRM THE ABOVE DETAILS ARE CORRECT AND UNDERTAKE TO NOTIFY THE CLUB OF ANY CHANGES. WE AGREE TO ABIDE BY
THE CLUB RULES & CODE OF CONDUCT AS STIPULATED IN THE CLUB HANDBOOK THAT CAN BE VIEWED OR DOWN LOADED ON THE
CLUB WEBSITE
PLAYER SIGNATURE:
PRINT:
PARENT SIGNATURE:
PRINT:
INFORMATION
 Club registration / ID card fee for the 2016-17 season: £20 per player (Cheques payable to WEST EXE YOUTH FC)
 Match & Training fees for the 2016-17 season: Training Session £2.00 per player collected in 10 week blocks. Match Fee £3.00 per player.
 All players must provide their own boots (trainers for astro turf) and shin pads which must be worn at all matches and training
sessions.
 Any player cautioned or sent off during a match are liable to pay their own league/county fine.
 Parents are hereby notified that by signing for your son/daughter to play for West Exe YFC you agree to transport him/her to the required
venue whether it is for training or matches. If you are unable to do this, by the signing of this form your permission has been granted for your
son or daughter to travel with the football club in the nominated transport and that all liability is with the parents giving that permission.
 The following player details will be submitted by the Club to the Devon FA along with a current passport photo in order to obtain a player ID
card :- Name, Address & Date of Birth. All players must have an ID card to be able to play competative matches.
TEAM MANAGER: PLEASE RETURN THE SLIP BELOW WITH REGISTRATION FEE (£20) TO THE CLUB SECRETARY. THE
ABOVE FORM MUST BE KEPT FOR YOUR OWN RECORDS AND BE AVAILABLE AT ALL MATCHES/TRAINING SESSIONS.
PLAYERS NAME:
FAN No.
ADDRESS
INCLUDING POSTCODE
CONTACT NAME / TEL:
DOB
TEAM/AGE GROUP
SCHOOL ATTENDING
£20.00 REGISTRATION/ID CARD FEE PAID BY CASH / CHEQUE
(PLEASE MAKE CHEQUES PAYABLE TO WEST EXE YOUTH FC)