Pro:Direct Trials - April 2021

Pro:Direct Bucks - Boys Trials

Wednesday 14th April 2021, 18:00 - 19:30, Thame Football Partnership AGP, OX9 3RN
Students Full Name *

First Name Last Name
Preferred Playing Position
D.O.B *

Month Day Year
Date
Student Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student Phone Number *

Country Code Area Code Phone Number
Student Email *
example@example.com
Name of Parent/Guardian *

First Name Last Name
Parent/Guardian Phone Number *

Country Code Area Code Phone Number
Parent/Guardian E-mail *
example@example.com
Please provide details of any medical conditions/allergies and medication required.
I give my permission for my child to take part in the Pro:Direct Bucks trial event. In the unlikely event of accident or illness I give my consent to any necessary medical treatment to be given by the nominated first aider. In an emergency If I am not contactable I give my permission for my son/daughter to receive hospital; I understand every effort will be made to contact the emergency contact listed on the application form as soon as possible.

I confirm that the details given are correct to the best of my knowledge.
I give my consent for photos/videos to be taken of my child for marketing purposes.

Yes No
Signature *

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Pro:Direct Bucks - Boys Trials