eREGISTRATION – Farringdon Detached YCFC

Membership & Medical Consent Registration

Please complete all 4-sections of this registration form. This form applies to all players in all age groups, including the Men’s Team.

PLAYER'S FULL NAME

PLEASE GIVE AN EMAIL ADDRESS SHOULD WE NEED TO CONTACT YOU ABOUT ANY OF THE INFORMATION YOU DECLARE ON THIS FORM

HOME ADDRESS & POSTCODE

CURRENT TEAM

PLAYING POSITION

ETHNIC ORIGIN

IF 'OTHER' SELECTED STATE ETHNIC ORIGIN HERE...

SUBSCRIPTIONS AGREEMENT

By checking this box, I declare that I know the amount payable and frequency of payment for club subscriptions.

MAIN EMERGENCY CONTACT/PARENT or CARER NAME

MAIN EMERGENCY CONTACT TELEPHONE NUMBER

2nd EMERGENCY CONTACT NAME

2nd EMERGENCY CONTACT TELEPHONE NUMBER

3rd EMERGENCY CONTACT NAME

3rd EMERGENCY CONTACT TELEPHONE NUMBER

PARENTAL CONSENT: Medical Attention

If my child is injured whilst playing football or travelling to and from football events and I cannot be contacted on the numbers I have given, I hereby give consent for my child to receive medical attention.

DOES THE PLAYER SUFFER FROM ANY OF THE FOLLOWING...

DOES THE PLAYER HAVE ANY ALLERGIES?

IF 'YES', WHAT IS THE ALLERGY?

DOES THE PLAYER SUFFER FROM ANY OTHER MEDICAL CONDITION NOT MENTIONED ABOVE?

IF 'YES', WHAT IS THE MEDICAL CONDITION(S)?

IS THE PLAYER TAKING ANY MEDICATION OR RECEIVING MEDICAL TREATMENT?

IF 'YES', ENTER MEDICATION, DOSAGE & FREQUENCY

DOCTOR'S NAME

DOCTOR'S ADDRESS

DOCTOR's TELEPHONE NUMBER

PARENTAL CONSENT: Medication

By ticking this box, I give my permission for the group leader(s) to administer it on my behalf at the dosage and at the times I have indicated. If any prescribed medicines listed above need to be administered under the supervision of an adult. The person agreeing to this declaration must have parental consent.

REGISTRATION AGREEMENT

I agree to be bound and to observe the Club rules and codes of conduct as set out in the Club Constitution and the Rules and Regulations of the Football Association Limited and Durham County F.A. and all competitions in which the Club participates. I also agree to support the FA RESPECT Campaign. See www.farringdondetachedyacfc.com for all Codes of Conduct and Rules. See www.thefa.com for rules and the RESPECT Campaign. • I consent to the processing of this information, in strict accordance with the Data Protection Act 1998. •I give consent for appropriate player photographs to be used in club material strictly in pursuance of the FA policy regarding the use of images. Full details can be found at www.thefa.com or by contacting the Club. •I understand that Farringdon Detached has Insurance for Public Liability but not for personal belongings or personal accident or (which must be purchased from the Durham County F.A. by paying a £1 when signing on with Farringdon Detached F.C. Club). AS A CONDITION OF MEMBERSHIP WE EXPECT ALL MEMBERS OF FARRINGDON DETACHED F.C. TO RESPECT ALL COACHES, STAFF, VOLUNTEERS AND PROPERTY CONNECTED TO FARRINGDON DETACHED F.C. AND ANY FACILITIES USED BY MEMBERS OF FARRINGDON DETACHED F.C.

Membership & Medical Consent Registration

*We will only hold onto your data until you leave the club.

MEMBERSHIP & MEDICAL CONSENT FORM

RESIDENTIAL CONSENT FORM

COVID GUIDELINES & DECLARATION FORM

CONTACT US

CLUB OFFICIALS

CHAIRMAN & WELFARE OFFICER / Ian Stewart

CLUB SECRETARY / Lisa Stewart

COVID-19 OFFICER / Gemma Kennedy

CONTACT / SOCIAL