Samba Futebol Club - Junior Registration Form

Samba Futebol Club

(NPO 2019/417148/08)

Junior Player Registration Form

venues across Pretoria

hub in Centurion with Satellites in Silverton and Lotus Gardens

(5 - 15-year-old boys and girls)

www.facebook.com/sambafutebolclubza
Player Names*

First NameMiddle NameLast NameGender
Player's Date of Birth*

YearMonthDay
Date
Player's ID number / Passport Number*
Nationality
Player Preferred Weekday Training Slot
Players Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Soccer Club
School Attending
1st Guardian / Parents Names*

First NameMiddle NameLast Name
1st Guardian / Parents Cell Phone*
Format: (000) 000-0000.
1st Guardian / Parents E-mail*
2nd Guardian / Parents Names

First NameMiddle NameLast Name
2nd Guardian / Parents Cell Phone
Format: (000) 000-0000.
2nd Guardian / Parents E-mail
example@example.com
1st Guardian / Parent2nd Guardian / ParentVolunteer Match RefereeClub Volunteer Admin ParentClub Volunteer Coaching Assistant Parent
I would like to play on the same team with following players. The Club will do their best to match this buddy list and your skill level.
Important Notes

Please note the club has lost access to the fields at the Waterkloof Base due to the COVID-19 pandemic and there will be using alternative venues for training. The Club will communicate with all those parents who have completed this form with regards to available facilities for them to choose which facility they would like to use for practice.

Samba FC is an NPO and therefore requires donations as well as volunteers to make it work. There is an annual registration fee of only R550.00 due upon registration for each player once we have reached the minimum numbers for each age group which includes the playing kit, league affiliation and team equipment. in addition to this, there will be monthly subscription fees due per player in each team based on the facility to be used, coaches allocated, player numbers and additional tournaments. This monthly subscription is on average R350.00 per month till the end of the year program.

The teams will be limited to 18 players for every two coaches. Samba insists on each team having one qualified coach per team assisted by volunteer parent coaches and admin parents.

We will be using the Karri App(www.karripay.com/za) for any funds raised and the admin parents will be given access to this platform to manage funds and this will be communicated once an age group team is established.

All Covid-19 Protocols to be observed.

https://sacoronavirus.co.za/
Emergency Contact & Health Insurance Information
Emergency Contact's Name*

First NameLast Name
Relationship*
please select
Phone Number*
Format: (000) 000-0000.
YesNo, I'll pay with cash.
Insurance Carrier
Name of Policy Holder
Subscriver ID/Group Number
Card Number / Card Date
YesNo
Please describe
Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Release of Liability

Although the safety of all sports activities is the primary concern, sports activities at Samba Futebol Club facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Samba Futebol Club and the persons in charge.
YesNo
Confirmation E-mail*
Signature*
After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at admin@sambasport.co.za
Samba Age Group
Should be Empty:

Release of Liability