Saturday Morning Football Club Registration - Brackley Town FC Player Development Centre

Saturday Soccer Schools - Registration

Registration for BTFC Saturday Soccer Schools - 4 to 6 year olds

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

Private & Confidential

Personal Details

Players Full Name(*)

Please input players name

Date of birth(*)

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House Number/Name(*)

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Road/Street(*)

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City/Town(*)

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County(*)

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Post Code(*)

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Main email where all communication will be sent(*)

Please specify your email address.

Contact Details

Please provide the details of two people who we can contact if required, one of which must be a parent/guardian.

Primary Contact

Primary Contact Name(*)

Please specify your name

Primary Contact Relationship(*)

Please specify relationship to child

Primary Contact Landline Number(*)

Please specify land line phone number, no spaces

Primary Contact Mobile Number(*)

Please specify mobile phone number, no spaces

Primary Contact Email(*)

Please specify email address.

Other Contact

Other Contact Name(*)

Please specify your name

Other Contact Relationship(*)

Please specify your relationship to child

Other Contact Landline Number(*)

Please specify land line phone number, no spaces

Other Contact Mobile Number(*)

Please specify mobile phone number, no spaces

Other Contact Email(*)

Please specify email address.

Medical Details

Childs Doctors Name(*)

Please specify your doctors name

Childs Doctors Street Number/Name(*)

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Childs Doctors Road/Street Name(*)

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Childs Doctors City/Town Name(*)

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Childs Doctors County Name(*)

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Childs Doctors Post Code(*)

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Childs Doctors Phone Number(*)

Please specify doctors land line number, no spaces

Is the player currently taking medication?(*)

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If yes, please provide details of the condition for which the player is taking medication, if none state 'None'

(*)

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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 stae 'None'

(*)

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Disclosure

• 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(*)

Yes Invalid Input

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

Parent/Guardian - I agree to abide by the Rules (*)

Yes Invalid Input

• Parent/Guardian - I give my permission for any appropriate medical treatment to be carried out

Parent/Guardian - I give my permission for any appropriate medical treatment to be carried out (*)

Yes Invalid Input

• Parent/Guardian - I agee that photos or video may be taken whilst the above named player is taking part in any club or league organised activity

MediaYesNo(*)

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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

These Newsletters will normally arrive in your inbox at most once a month unless we have some urgent news that we think you might be interested in. There is an unsubscribe link on all newsletters, so you can unsubscribe at any time

Items marked with an * are required.

Once form completed click on 'Submit my registration' below.

You will receive an automated email confirming your registration

Thank you for your support BTFC Player Development Centre

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