Silsden AFC Juniors – Membership Registration Form Season 2007-08

 Players Full Name _____________________________Date Of Birth__________________
 Ethnic Origin _____________________________________________________________________
 School Attended__________________________________________________________________
 Parents Name(1) _________________________Mobile No__________________________
 Parents Name(2) _________________________ Mobile No_________________________

 Parents Occupation
 1)___________________________________2)____________________________________
Address ____________________________________________________________________
 Post Code_______________________ Home Tel No ________________________________
 E Mail _____________________________________________________________________

 Non Playing Skills That Either Player or Parent Is Willing to Help Out With  (please tick)
       Coaching____________Administrator______________Fundraising_______________Other______________

 Medical Details*

                           Please indicate if you have any medical conditions that we should be aware of: 
         _____________________________________________________________________________

(*Signature of this form below by the parent / guardian indicates full consent / agreement for the child to          participate in all football activities at Silsden AFC Juniors)
 Emergency Contact Details
 Name(s) ______________________________Emergency Tel No_______________________________
 Name(s) ______________________________ Emergency Tel No ______________________________

 Parental Consent
                     In the event that my child is injured whilst training / playing football / travelling to and from football matches and I cannot be contacted I hereby give my consent for my child to receive medical attention

 Rules
  I agree to be bound by and to observe the Club Rules and The Club Code of Conduct, the Rules and Regulations of the Football Association Limited and the County Football Association and all competitions in which the club participates
                                                                          Signed     _________________________________

Players Picture PASSPORT PHOTO WITH COPY OF BIRTH CERTIFICATE (Copy Only) AND £1 KEYBURY REG FEE AND SILSDEN FEE

 Notes – Silsden AFC Juniors charges:
Club Signing On Fee, Match Fees and Training Fees to be advised by team manager