MEMBERSHIP REGISTRATION FORM
TEAM DETAILSAge Group / Name of Manager
PLAYER DETAILS
First Name(s) / Surname
Date of Birth / School / School Year
Player Position(s) / Goalkeeper / Defender / Midfield / Forward
PARENT / GUARDIAN DETAILS
Title (please tick) / MR / MRS / OTHER
(please state)
First Name(s) / Surname
Date of Birth
Address
Home Tel No / Mobile No
PLAYER MEDICAL CONDITIONS / PARENT / GUARDIAN CONSENT
Please indicate if your child has any medical conditions that we should be made aware of. / 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
SIGNED:
Celebrating Football through Photo & Video
At times the Club may wish to take photos & videos of the team or individuals. We adhere to The FA Guidelines to ensure these are safe & respectful & used solely for the purposes for which they are intended, which is promotion & celebration of the activities of the Club & for training purposes. If you DO NOT wish images of your child to be used please tick here
EMERGENCY CONTACTS
(In the event that the above named person cannot be reached, please provide details of two additional emergency contacts)
Name / Name
Contact No / Contact No
PAYMENT(£25 Signing on Fee. Subscriptions are set at £15 per month for u10s and below and £20 for u11s+)
Please make all cheques payable to STONEYGATE LIONS F.C.Club Account details Sort Code 54-21-50 Account Number 30243971
Annual Club Signing-On Fee - £25** (please tick)
ChequeCash Online / Subscriptions: Please indicate payment frequency and method
Half Yearly U10s and below £60. U11s+ £80
2 Payments due in September & January
Yearly U10s and below £120. U11s+ £160
1 Payment due in September
ChequeCash Online
SIGNED
Player / Parent / Guardian / Date
**Please attach payment to form. Reduced to £5.00 for development sides still training with the Academy