Club Registration Form | Ballykeel Youth

BALLYKEEL YOUTH FOOTBALL CLUB - REGISTRATION FORM

Players Forename

Players Surname

Players Date of Birth

Nationality

Country of Birth

Players Address Including Postcode

Telephone No

Mobile No

Email Address

Name of Doctor

Practice name

Practice address

Phone number

Please List any Medical conditions, Allergies or Medication that your Child is taking.

Emergency Contact Number

As a player / parent, it is important that you disclose to your Team Manager any information relating to
safety and welfare of you / your child.

This information may relate to any of the following:
- health needs such as asthma, diabetes, epilepsy, etc
- current medications which you / your child may be taking
- Communication needs (speech impairment, hearing difficulties, etc)
If applicable please describe above:

I understand that it is my responsibility to keep the club updated with all relevant information, especially
emergency contacts and medical details. I understand that in the event of any injury or illness, all reasonable
steps will be taken to contact me, and I give permission for the club and/or any medical authorities present, to
administer any appropriate or necessary medical attention.

Parent Signature

I give consent, for the purposes of the Data Protection Acts, to the Club holding and processing the
data on this form for the purposes of the Club including using the data to communicate with members
in relation to matter relating to the running of the Club and Club activities.

Parent Signature

I give consent for my child to participate in CP Football Development Academy's activities and events
and accept that it is my responsibility to inform the Team Manager directly of any particular
requirements for my child.
I hereby give consent for photographs and images of my child to be taken and use solely for team or
club purposes including publication on the Clubs website / Facebook page.

Parent Signature

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