Hampsthwaite and Birstwith JFC Player Registration Form for NEW PLAYERS ONLY

This form is for NEW PLAYERS ONLY. As a new player, you will not have to pay for a subscription until your child is happy.

Select Current Season
Select School Year Group. From September 2023

This would be the school year when the player returns in September 2023.
Players Name Players Name First Last
Date of Birth Date of Birth / DD / MM YYYY
Address Address
Street Address Address Line 2 City County Postcode Country
Contact Telephone Number
Email

Confirm Email Address
Medical Conditions
Has the Player any Serious Medical Conditions?

Has the Player any Serious Medical Conditions? Yes No
If Yes, please list all serious medical conditions
If yes, please confirm that you consent to the Club holding this special category data in
respect of your child on the Club’s central player register and informing your child’s coach of
the condition:

If yes, please confirm that you consent to the Club holding this special category data in
respect of your child on the Club’s central player register and informing your child’s coach of
the condition: Yes No
Emergency Contact Details

Please provide at least one emergency contact.
1st Emergency Contact Name 1st Emergency Contact Name First Last
1st Emergency Contact DOB 1st Emergency Contact DOB / MM / DD YYYY
1st Emergency Telephone
Relationship To Child
2nd Emergency Contact Name 2nd Emergency Contact Name First Last
2nd Emergency Telephone
Relationship To Child
Current Photograph of the Player

Please upload a current photo of the player. This photo will be used on the Player's registration file and needs to be a good likeness of the Player.
Click the button below to upload your photograph

Attach Files
Club Marketing

From time to time we may contact you about club information and news. If you are happy to receive this information by email please tick the box.
Yes
Data Policy:

o The data collected on this form will be stored on the Club Player Register which is accessible only
by the Club Chairman and Secretary. A shortened form will be passed to your child’s coach.
o Certain data will also be entered onto the FA’s Whole Game System which is a club requirement as
a club affiliated to the FA.
o Special category health information is required to ensure the health and safety of your child.
o Full information on the way we process, store and collect information about you can be found on
the Club’s Privacy Policy at www.hbjfc.co.uk
Parent's / Guardians Signature

I, the parent or guardian, of the player named above hereby:

i) Agree to be bound by and to observe the Club rules.

ii) Agree to my child receiving medical treatment in the event that my child is injured while playing football.

iii) Recognise, acknowledge and understand the following:

• My child's participation in the Activity (football undertaken at HBJFC) carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries;

• My child is physically able to participate in the Activity and I know of no disability or prior
injury which would prevent my child's participation in the Activity or potentially lead to
my child becoming injured or the injury of another;

• My child's participation in the Activity is voluntary and is at his or her own risk.

• Notwithstanding the above risks, which I recognise and accept, and in consideration of being permitted to participate in any way in the Activity, I, for myself and my child, do hereby waive, release and discharge HBJFC, the club's officers, and officials from any and all claims for personal injury, accidents, or illnesses (including death), and property damage arising in any manner out of my child's participation in the Activity, including transportation to and from the Activity.
Confirmation of Information Supplied

Confirmation of Information Supplied I agree the information given above is correct
Please sign in the box below to confirm the above details are correct.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Please Submit this Form to confirm you child's registration.

Hampsthwaite and Birstwith JFC Player Registration Form for NEW PLAYERS ONLY

Hampsthwaite and Birstwith JFC Player Registration Form for NEW PLAYERS ONLY

Medical Conditions

Emergency Contact Details

Current Photograph of the Player

Club Marketing

Data Policy:

Parent's / Guardians Signature

Please Submit this Form to confirm you child's registration.