Parent's Name
*
First Name
Last Name
Your Phone
*
Country
(###)
###
####
Your Email
*
Team of Registration
*
U5 - Josh Groombridge
U6 Amazons - Andy Sims
U6 Boys - Mikey Conlon
Child's Name
*
First Name
Last Name
Child's Date of Birth
*
MM
DD
YYYY
Names of Any Other Parents/Guardians
Please list their name(s) and their relationship to the child.
Emergency Contact 1 Name
*
First Name
Last Name
Emergency Contact 1 Phone
*
Country
(###)
###
####
Emergency Contact 1 Relationship to Child
*
Emergency Contact 2 Name
*
First Name
Last Name
Emergency Contact 2 Phone
*
Country
(###)
###
####
Emergency Contact 2 Relationship to Child
*
Medicine/Food Allergies
*
Other Medical Conditions
*
Additional Relevant Information
Code of Conduct Affirmation
*
Insurance Consent
*
It is necessary for the club to receive your consent on our ability to transport our players, if necessary, for insurance purposes.
Medical Consent
*
It is necessary for the club to receive your consent to provide or facilitate medical treatment for your child in the event you cannot be contacted with your contact information provided on this form. We will endeavour to contact your emergency contacts as well, but in emergency situations immediate action is always necessary.
Photography Consent
*
From time to time, our organisation will take photographs of our operations in action for promotional, educational, and celebratory purposes. UJFC always pledges to create visual and audio-visual content in the most professional and respectful manner possible in respect to our players and volunteers.
Payment via Direct Debit
*
Date of Signature
*
MM
DD
YYYY
