Luton United FC Member Registration - Season 2019/20

 

Online Registration Form

Type of Membership
 *
Players First Name
 *
Players Last Name
 *
Date of Birth
   *
Players Address 1
 *
Players Address 2
 *
Players Post Code
 *
Current School
 *
School Year From September 2019
 *
Please provide 2 passport sized photographs and a photocopy of their passport or birth certificate. Pictures taken by mobile phone will be accepted.
Passport Sized Photo 1
Upload file *
Passport Sized Photo 2
Upload file *
Photocopy of passport or birth certificate
Upload file *
Next of Kin - Please make sure this information is accurate as it will be used in case of an emergency.
Parent/Guardian Full Name
 *
Parent/Guardian - Relationship to Player
 *
Player/Guardian - Address if different from player
Parent/Guardian - Home Telephone
 *
Parent/Guardian - Mobile Number
 *
Parent/Guardian - Email Address
 *
Parent/Guardian - Occupation
Medical Information. Please fill in best as you can
Family GP Name
Surgery Name
Surgery Address
Surgery Phone Number
Medical History. This information will be used in case of any emergencies.
Does your son/daughter have any conditions requiring medical treatment?
 *
Does your son/daughter have any known allergies?
 *
Does your son/daughter ever become more breathless than his friends on strenuous exertion?
 *
Has your son/daughter ever experienced palpitations either on exercise or at rest?
 *
Does your son/daughter suffer from asthma or diabetes?
 *
 *
Name
 *
Relationship to Player
 *
Date
 *
I understand that our photos can be removed and deleted by contacting our child?s coach or committee member of Luton United FC. If you do not wish you, child, to be photographed, please tick this box
Do you agree to the below?
 *
I agree to my son/daughter receiving medication as instructed or any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present and in the absence of a parent/guardian. I accept the extent and limitations of the insurance cover provided (copy available on request).
I have read and understood the codes of conduct and agree to abide by them
 *
1. Details of Football activity. I agree to my child taking part in football activity and further agree to the need for my child to behave responsibly, and to observe the code of conduct for players. 2. Fines. I agree that I will be responsible for the payment of any fines that may be levied on my child, for his or her misdemeanours, by the Football league with which the team is registered. 3. Statement of Risk Appreciation and Liability Agreement. I understand that in participating in football, my child will be exposed to possible risk of injury, such as bruises, cuts, pulled and torn muscles and ligaments etc. I hereby consent to my child playing football and agree that in the event my child is injured, I will not in any way hold Luton United Football Club nor its Officers or Managers liable for any claims or demands relating to such injury. I further agree that I will inform Luton United Football Club of any medical condition that my child has before his or her participation. 4. Changes of Circumstances. I agree to advise Luton United F. C. of any changes of circumstances which may affect this registration. i.e. Address, medical etc. 6. Use of Photographs. I consent and hereby give Luton United FC, permission to use photographs of my child, for any of the following uses: Luton United FC website, advertisements, marketing, leaflets or any other use such as training, educational or publicity purposes.
Ethnicity
Please select your ethnicity
 *
A receipt will be automatically emailed to the email address above on completion of your booking. Please allow 30 minutes to receive your receipt.

All payments are NON-REFUNDABLE

We take the responsibility of protecting your data and your privacy very seriously and will only use your personal information to administer your account and to provide the products and services you have requested from us. Unless we are obliged by law to do so, your data will NOT be disclosed to third parties. Details extracted from membership forms are stored on computers for use by the officers of Luton United F.C.  Should any one object to such information being electronically stored please inform the Club Secretary in writing as soon as possible. Processing of application forms and other details will then be dealt with using manual processing methods.

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