Player Registration

 

Team:
First Name:
Middle Name:
Last Name:
Date of Birth:
Age:
Sex: M F
Street Address:
City:
Country:
Post Code:
School:

Parent/Guardian Information

Last Name:
First Name:
Street Address:
City:
Post Code:
Home Phone Number:
Work Phone Number:
Mobile Phone Number:
Email Address:

In Case of Emergency

In the unlikely event that we are unable to contact you on any of the above numbers please provide an alternative name and contact details:

Name:
Relationship to player:
Contact Number:
In the event that I cannot be contacted on any of the above numbers, I give consent for my child to receive medical attention.

Medical Details

Please indicate in the box below any medical conditions that the Club should be aware of AND ANY medication taken.


Permission for sharing photos on website/social media

I do agree: I do not agree:

Declaration

I agree to abide by the rules and regulations of Harpenden Rovers Youth FC.