Downley Dynamos Football Club - Player Registration form 2016/17 Season

Please fill in the below registration information, * is a required field and must be entered.

Player Information

Player First Name: * Player Last Name: *
Date of Birth: (dd/mm/yyyy) * Age Group: *
School Attended: * School Year: *
Home Address 1: *
Home Address 2:
City: *
County:
Post Code:
Other Siblings at Downley Dynamos (name & age group):

Parent/Guardian Information

Parent/Guardian Name: *
Telephone Home:
*
Telephone Mobile:
Contact E-mail Address (for team selection,fixtures,cancellation etc.): *
Alternative Contact Name: *
Telephone Home:
*
Telephone Mobile:

Medical Information

Do you consent to emergency First Aid being given to your child?:
*
Is your chid allergic to sticking plasters?:
*
Does your child have any other allergies or medical conditions?:
*
If YES, then please provide details and any medication required:

Subscriptions

Please select Subscription payment:

* Payments not taken online and will need to be handed into your coach with a cheque or cash and a copy of the registration form which will be emailed you on completion

* January payments preferably in the form of a post-dated cheque with the September payment

Match Fees

U7 - U11 - ₤1.00 (per match)

U12 - U18 - ₤2.00 (per match)


:
Signature (parent/guardian) Please Type full name: * Date: (dd/mm/yyyy) *