Season: 2018/19 / Age Group
SECTION 1 - PLAYERS DETAILS
Full Name: / Date of Birth:
Address (including postcode) / Home Number
Mobile Number
Parent/guardian names / School attending
SECTION 2 – EMERGENCY CONTACTS (please provide 2 further emergency contacts)
Name: / Relationship: / Contact Number:
Name: / Relationship: / Contact Number:
SECTION 3 – MEDICAL/ DISABILITY INFORMATION
Please provide details of ANY medical condition/disability we should be aware of.
Please state any medication your child takes for this condition.
SECTION 4 – VOLUNTEERING
As with many clubs we rely on the support and help of volunteers, if you are willing to assist in any way please tick as appropriate.
Committee / Coaching/ team assistance / Fundraising / Matchday Café
Other (please specify)
SECTION 5 - PARENTAL CONSENT
Increasingly we are using social media (eg Facebook, Instagram and Twitter) to promote the club to the local community and beyond.
In order to comply with the Data Protection Act 1988 and our Child Protection Policy, please tick one box to provide your permission for us to photograph or make recordings, of your child and share them in the manner described. / I am happy for my child to be filmed and photographed
I am NOT happy for my child to be filmed and photographed
Additionally as a parent/guardian we ask you to be mindful about sharing any images you take for yourself that may include children other than your own.
Caerwent JFC is committed to safeguarding the privacy of your child’s personal data. The personal data supplied on this form is the minimum necessary for the us register your child to play football. Your child’s data will be held in accordance with data protection legislation and principles and as per the provisions of the General Data Protection Regulation (GDPR). The information that we are obliged to provide you in accordance with the provisions of the GDPR is contained on our website
- As parent/guardian of my son/daughter I agree to them taking full part in football matches and training sessions arranged by the club.
- In the event that my son/daughter is injured whilst playing football/travelling to and from football events and I cannot be contacted on the above number, I hereby give my consent for my child to receive medical attention.
- I agree to be bound by and to observe the Club Rules and The Rules and Regulations of The Football Association of Wales Ltd, The Area Football Association, Junior League and all competitions in which the Club participates.
Signature: / Date:
Print Full Name
The above information is PRIVATE and CONFIDENTIAL and is to be retained for Club’s use only.
All information will be stored securely and is not shared with any third parties