Welland FC Application Form

Please read the code of conduct before signing this form - Thank you

Team:

Office Use Only - Monies Received:

2022/2023

PLAYER FEES

£40

Affiliated to Worcestershire FA

Players Name *

First Name Last Name

Birth Date *

Month Day Year

Team Registered with last Season: *

Please enter your full address and postcode for registration.

Home Address: *

Street Address

Street Address Line 2

City County

Postal Code Country

Players E-mail *

Mobile Number *

Home Number

Please type in area code.

Emergency Contact Name: *

Full name please

Emergency Contact Number *

Please type in area code.

The following information is as a precaution against an accident occurring when parents/next of kin cannot be contacted & will be treated in total confidence.

Players Doctors Name: *

Surgery Address: *

Surgery Number:

Please type in Area code

Medical Conditions: *

Please indicate any medical conditions/ allergies/ disability or learning need of which a Doctor or Club Coach should be advised.

Welland Football Club’s official web site can be found at www.wellandjuniorfc.co.uk & contains important information about the running of the Club. Please inform organisers in writing if you do not want your picture to be used on the website or on social media platforms. Please Note – Individual names are not put against photos used but may appear in match reports unless pre-consulted with player and guardian.

Welland Football Club permits official photographs with names to appear in the press and the video recording of games in accordance with FA guidelines.

Welland Football Club cannot be held responsible should accidents occur when members are travelling to matches/tournaments/training etc. We strongly advise all drivers to have a comprehensive motor insurance policy.

Welland Football Club have Personal Accident Cover in place for all registered players. For more info please contact the club Secretary.

Welland Football Club’s ‘Code of Conduct’ can be found on our junior club website but a copy will also be provided at signing on process.

For League Registration purposes please be aware that player details are now submitted on-line via the FA’s ‘Whole Game System’ by the Club Secretary or Team Manager.

UNDER 18s PLAYERS ONLY: Please note that there may be use of shared communication platforms such as Facebook and WhatsApp, match day changing facilities and Emergency 1st aid treatment required during training fixtures. Therefore, as parent/guardian you are signing to give your consent for your child to part take in these.

By Signing below you consent to joining Welland Football Club.

Parent Signature if Child under 18

As a Parent/Guardian of a Welland FC Player, I agree to act in accordance with the Club’s ‘Code of Conduct’ and consent to all of the above. Clear

If registering a child under 18 please provide your date of birth for registration.

Parents date of birth

Month Day Year

Players Signature *

As a Player of Welland FC, I agree to act in accordance with the Club’s ‘Code of Conduct’ Clear

Data will be managed in accordance with The General Data Protection Regulation (GDPR)

Please email the Club Chairperson “In confidence” if you do not wish to receive emails from the Club relating to Club information, Training, News and Events: info@wellandjuniorfc.co.uk

www.wellandjuniorfc.co.uk

FOR OFFICE USE ONLY - MANAGERS SIGNATURE

SIGN BELOW:

Managers Signature

Office use only. Clear

Welland Football Club Membership Application Form