Blue Stars Elite FC Registration Form

Blue Stars Elite FC
Membership Registration Form
Childs Full Name*
Age*
Date Of Birth*

DayMonthYear
Date
Age
Date Of Birth

DayMonthYear
Date
3rd Childs Full Name (Leave blank if no other child is attending)
Age
Date Of Birth

DayMonthYear
Date
Address*
Post Code*
MEDICAL DETAILS
Please indicate if you have any medical conditions that we should be aware of. (Please include child's name if you have more than 1 at our club)*
EMERGENCY CONTACT DETAILS
Emergency Contact Full Name*
Emergency Contact Date Of Birth*

DayMonthYear
Date
Relationship to child*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
2nd Emergency Contact In the event that the above named person cannot be reached, please provide a
2nd Emergency Contact Full Name*
Relationship to child*
Emergency contact telephone number*
Medical Consent - I give consent that in any emergency situation, if the need arises for the admission of emergency first aid and/or other medical treatment, permission is given to do so. (Only if contact has not been made to either emergency contacts). *
FOOTBALL TRAINING DAYS & TIMES

Wednesday 5:00pm - 6:00pm (Burgess Park Astro Pitch) 6 - 16 year olds

Saturday 10:00am - 12:00pm (Burgess Park Astro Pitch) 6 - 16 year olds
will your child be making his/her own way home?*

NoYes
PAYMENTS
£25 will need to be paid on the day your child starts.

Membership fees will be £25 a month and will cover training 2 times a week.

Payments will be needed by the 1st of every month (CASH PAYMENTS TO BE MADE ON A SATURDAY TO LEANE)

LATE PAYMENTS WILL NOT BE TOLERATED AND MAY MEAN EXCLUSION FROM TRAINING!

Payments can be made by cash or paid directly into the club bank account (details below

Bank Account Name: Blue Stars Elite FC

Account Number: 70492418

Sort Code: 20-45-45

Reference: (CHILDS NAME)

(Please make sure you use your child's name as a reference when making bank payments, for us to identify who has made the payment.
SUNDAY LEAGUE MATCHES
Would you like your child to be part of the Sunday matches? (Please note: Your child will have to attend every match and you will also have to take your child. Also we will need to check if there is space on the team. If you cannot commit to your child attending every Sunday and taking them please do NOT select yes).*

YesNoUnsure/Maybe
Photo sharing

Occasionally we may wish to share photos of our team players training, to our website and social media. If you DO NOT agree to your child's photo being shared, please tick here:
By signing this form, you agree to make payments ON TIME EVERY MONTH or risk losing a place at the club.
Signature*

Clear
Print Name*
Date*

DayMonthYear
Date
Chairman: Kevron Mckay -07828783225

Secretary: Leane Horsley-07554994035

Email: info@bluestarselitefc.co.uk
Should be Empty:

Blue Stars Elite FC

Membership Registration Form

MEDICAL DETAILS

EMERGENCY CONTACT DETAILS

PAYMENTS