Badshot Lea Colts Membership 2018/19

 

Online Registration Form

Player First name
 *
Player Last name
 *
Date of birth
   *
School Year
 *
School (From Sept)
 *
Badshot Lea Team Name:
 *
Parents, Guardian & Carers Main Contact
Parent/Guardian First Name
 *
Parent/Guardian Last Name
 *
Relationship with player
 *
Parent/Guardian Home Number
 *
Mobile
 *
Email
 *
Address Line 1
 *
Address Line 2
City / Town
 *
Postcode
 *
2nd Contact
2nd Contact First Name
 *
2nd Contact Last Name
 *
2nd contact relationship with player
 *
2nd Contact Home Number
2nd Contact Mobile Number
 *
2nd Contact Email Address
 *
2nd Contact Address Line 1
 *
2nd Contact Address Line 2
2nd Contact Town/City
 *
2nd Contact Postcode
 *
Emergency Contact
Alternative Emergency Contact First Name
 *
Alternative Emergency Contact Last Name
 *
Alternative Emergency Contact Relationship With Player
 *
Alternative Emergency Contact Home Number
 *
Alternative Emergency Contact Mobile Number
 *
Alternative Emergency Contact Address Line 1
 *
Alternative Emergency Contact Address Line 2
Alternative Emergency Contact City/Town
 *
Alternative Emergency Contact Postcode
 *
Medical Information
Does the player have any known health issues (e.g. Diabetes, Asthma, Epilepsy, Allergies) (If yes please complete the section below or contact the Club Welfare Officer
 *
Regular Medication
Dosage/Frequency
Do club members need any medical training other than First Aid to care for the player (please specify)?
 *
Photograph Consent
At times the Club may wish to take photos of videos of the Teams or individuals. We follow FA Guidelines to ensure these are safe and respectful, an used solely for the purpose of which they are intended, which is for promotion and celebration of Football Club activities and for training purposes. Please indicate if this is acceptable to you
Promotion/Celebration of Football Club activities - Opt In
 *
Dosage/Frequency
Dosage/Frequency
Training purposes - Opt In
 *
Email Consent
At times the club may wish to contact you via email regarding club news, key club dates, club newsletters, club promotions and volunterring help, to be subscribed to these emails please indicate if this is acceptable to you (The Club will never pass on your personal data to any 3rd parties without the data owners explicit permission)
Club Newsletters - Opt In
 *
Club Promotions - Opt In
 *
Club Volunteering Help - Opt In
 *
Data Consent

The Club wish to pass on Parents / Guardian / Carers contact information including any pre existing health / Medical conditions to your childs team manager / coach / assistant / administrator Please indicate if this is acceptable to you (The Club will never pass on your personal data to any 3rd parties without the data owners explicit permission)

Contact information - Opt In
 *
Medical Information - Opt In
 *
Badshot Lea Football Club, expects it Coaches, Players and Spectators to abide by the clubs 'Code of Conduct', these can be found at www.badshotleafootballclub.co.uk/welfare or can be issued in print at request of the club, please ensure these documents are read and understood before committing to the club.
 *
 *
 *
 *
A receipt will be automatically emailed to the email address above on completion of your booking. Please allow 30 minutes to receive your receipt.
Visa Master Card
Secure Payments
Powered by Participant