Standard Player Registration Form Season 2016/2017

SECTIONA

Nameof Club

STANDARD PLAYER REGISTRATION FORM SEASON 2016/2017

Combined Counties Football League

All playersmustberegisteredinaccordancewithcurrentLeague,ProvincialandFAIRules

ClubSecretary Last Name Club Secretary First Name Player's Last Name Player's First Name Player's Status

Player'sStreet Address

Non-AmateurAmateur

Player'sTown/City

Player'sCounty

(orDublin Area Code)

Dateof Birth (DD/MM/YYYY)FAIRNumber

Player'sEmail Address

(Parent/Guardianemail if under 18)

Player'sContact Telephone Number

(Parent/Guardiannumber if under 18) ClubLast Registered/Date League Last Registered/Date

SECTION B

(Tobe completed if Player is under 18 years of age giving authority to the Player being registered with the League and/or Club)

Parent/GuardianLast Name

Parent/GuardianFirst Name

Parent/GuardianSignature

Ihereby consent to be registered as a player for <

spacereserved for club name

(not having signed by any other club) to play in the

space reserved for league name

>forthe season <16/17>. Once signed, I agree to abide by the rules of said l.league and the FAI.

Player'sSignatureDate

(DD/MM/YYYY)

ThedetailsyouprovideonthisformwillbeusedandstoredbyyourClubandaffiliatedLeagueandmayalsobesharedwithotherClubs,Leagues,NationalandDivisionalassociationsandtheFAIforpurposesofyourparticipationinallfootballrelatedactivity.YourdatawillbestoredincompliancewiththeDataProtectionActsandwillnotbesharedwithanyotherbodyororganisationwithoutyourconsentunlesssuchsharingofinformationisnecessaryforyourparticipationinfootballcompetitionsandactivities.

TheFAImayforwardinformationofinterestto youinrelationto events,commercialactivities,ticketingarrangementsorotherrelatedactivities.Pleasetickthisboxifyoudonotwishto receiveanysuchinformation?

ClubSecretary's SignatureDate

(DD/MM/YYYY)

SECTION C

(Tobe completed by League on receipt if Sections A and B are fully completed)

DateForm ReceivedDate Eligible to Play

LeagueSecretary/Registrar's Signature

BysigningthisformasLeagueSecretary/Registrar,youagreethatthePlayerdetailsprovidedonthisformwillbestoredincompliancewiththeDataProtectionActsandwillonlybeusedforfootballrelatedactivity

asenteredintobytheplayer.

Date

LeagueStamp

Date