Player Registration Form


Please complete this form in block capitals.
In addition each player’s registration form will need to be accompanied by a new digital image to be provided by the
player/parent/guardian or to be taken by a club official for use during the online registration process and for players
who have not previously registered with the league a proof of identification (birth certificate, passport etc) will be
required.
JPL Club Name: …………………………………………………………… Age Group: U…..…. (season 2015 / 2016)
Player name:……………………………………………………… Date of birth: ……../ ………../ ………….
Full Address:………………………………………………………………………………………………………
………………………………………………………………………………… Postcode……………….……..
School attended: ………………………………………………………………………………………….………
Club supported: …………………………………………………………………………………………………..
Sunday club name (if any): ……………………………………………………….………………………..……
Played in JPL Before: Yes / No [This is important as it will help the club during registration process]
Any allergies/medical conditions (if so please detail any medication):………….…………..……………….
……………………………………………………………………………………………………………………….
Primary Contact Details.
Main Parent/Guardian name: ………………………………..……………………………………………………
Email address: ……………………………………………. Emergency tel. no: …..…………………………….
Acceptance of Entry Conditions




We the undersigned confirm we have read the Junior Premier League Code of Conduct and agree to fully abide by it.
We are also aware that by signing the registration form you give permission for the League to display the player's name
and his match data on the league website in the future. You also give consent for the league and any of its appointed
sponsors/partners to take photographs or video which may include the player for use by the league and its
sponsors/partners as deemed appropriate. We will always work within child protection guidelines and best practices when
displaying images or details on a website or within any literature.
We also confirm the accuracy of the details entered on this form and understand that false information could result in
expulsion from the league.
We give permission for any emergency medical treatment to be carried out whilst attending any league competition.
Signed by Player: .........................................................
Date: .........../.............../...........
Signed by Parent/Guardian: ......................................................
Date: .........../.............../...........
I, the undersigned Club Official, acknowledge this player must not play in any JPL events until our club have entered
the registration details online and the League's Official Validation Process has been fully completed (Details available
online)
Signed by Club Official/Secretary:........................................................... Date: .........../.............../...........
CLUB KEEP