Walking Football Registration

Walking Football Registration 2023/2024 Season

Attachments

Player Image

We need an uptodate head and shoulder image of player, copy of passport with image not acceptable to the FA.

Birth Certificate

If you dont have copy of players birth certificate copy of passport should be okay..

File formats: .jpg ONLY. Maximum file upload size 300KB

Copy players birth certificate(*)

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Players photograph passport size(*)

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Password(*)

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Should you have any issues using this form please contact Mike on mike@brackleytownfc.co.uk. Please do not contact/email anyone else as this will be your quickest way to get an answer to your problem

Items marked with an * are required.

Please provide the details of Next of Kin who we can contact if required.

Next of Kin Contact Details.

Next of Kin Contact Name(*)

Please specify your name

Next of Kin Relationship(*)

Please specify relationship to child

Next of Kin Date of birth(*)

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Next of Kin Email(*)

Please specify your email address.

Next of Kin Landline Number(*)

Next of Kin Landline Number, number, no spaces

Next of Kin Mobile Number(*)

Please specify mobile phone number, no spaces

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Players Personal Details

Players Full Name(*)

Please input players name

Players Date of birth(*)

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Players Email(*)

Please specify email address.

Players Mobile Number(*)

Please specify mobile phone number, no spaces

Players Landline Number(*)

Please specify land line phone number, no spaces

Players Road/Street(*)

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Players House Number/Name(*)

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Players City/Town(*)

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Players County(*)

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Players Post Code(*)

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Medical Details

Doctors Name(*)

Please specify your doctors name

Doctors Street Number/Name(*)

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Doctors Road/Street Name(*)

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Doctors City/Town Name(*)

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Doctors County Name(*)

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Doctors Post Code(*)

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Doctors Phone Number(*)

Please specify doctors land line number, no spaces

Is the player currently taking medication?(*)

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Is player suffering from any medical conditions that we should know about such as,allergies, medication, physical disabilities, epilepsy, asthma, autism, ADHD etc. It is imperative that you let us know of all medical conditions that players suffer from, please provide details of the conditions that the player suffers from along with what medication the player is taking, if none state 'None' you should also let us know of any conditions that develop after you have registered. YOU SHOULD REMEMBER THAT IT IS YOUR RESPONSIBILTY TO COMPLETE THIS DECLARATION TRUTHFULLY. BTFC staff are not allowed to administer medication.

(*)

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Has the player been in hospital recently (previous 12 months)?(*)

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If yes, please provide details, if none please state 'None'

(*)

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Has the player ever suffered from any injury which you feel we should know about?(*)

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If yes, please provide details, if none please state 'None'

(*)

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Items marked with an * are required.

Disclosures

• Player - I agree that photos or video may be taken when I am taking part in any club or league organised activity

I agree that photos or video may be taken when I am taking part in any club or league organised activity(*)

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• Player - I agree to abide by the Rules and Codes of Conduct of Brackley Town Football Club, the league, and the FA

Player - I agree to abide by the Rules and Codes of Conduct of Brackley Town Football Club, the league, and the FA(*)

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Items marked with an * are required.

Finally, to complete registration you must read and agree the following

I accept that some of information completed on this form may be added to your league & club website. Tick box below to confirm acceptance

I accept that some of information will be added to relevant league website(*)

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Our Safegurading & Data Privacy Policies can be read HERE tick box below to confirm acceptance

I have read and accept Our Safeguarding and Data Protection & Privacy Policies(*)

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You will be added to our mailing list

BTFC Newsletters keep you updated on what’s new at Brackley Town FC including:

Latest team news - Football in the community news - Saints Community project news - And more

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Items marked with an * are required.

Once form is completed click on 'Confirm My Registration' below

You will receive an automated email confirming your registration for the 2023 -2024 season

Thank you for your support BTFC Player Development Centre

Walking Football Registration - 2023/2024 Season