RKFC Monday Night Football Booking Form

Player's Information

Parent/Guardian Information

Informed Consent and Acknowledgement

By completing and signing this form the above player or parent/guardian of the player agrees to abide by Richmond & Kew Football Club ("RKFC"), Kew and Ham Sports Association (“KHSA”), Football Association (“FA”), Southern Amateur League (“SAL”), and any other applicable Codes of Conduct, and read the club's Safeguarding and Equality Policies.

Please note that should any of the above contact details change whilst a member of the Club the parent / guardian must immediately inform the club of the changes. Unless the club is advised in writing (letter or e-mail), you agree to photos of you/your child being published, unnamed, on the club website and other publications approved by the club. For further information please visit the club’s website at www.richmondandkewfc.co.uk where you can find news bulletins, results, fixtures and Member’s/Parent’s Guides. RKFC is a Community Club providing an environment for players of all ages and ability to enjoy the game of football, to compete fairly, skilfully and within the rules of the game.
 
IMPORTANT INFORMATION: Please note that due to legislation changes affecting Data Protection, we as a club must inform parents/guardians completing this form that it, and the personal data contained on it, will be stored safely and securely, and in line with the Club’s Data Protection Policy. This form and the personal data on it will be retained for a maximum period of 24 months, after you inform us that you have left the club.. A parent/guardian signing this document should be aware that, in doing so, they are giving consent for their son/daughter's data being used for the purpose outlined in the policy which is predominantly to register you or your child to the relevant league and general club communications. The club understands that consent can be withdrawn by the person giving it at any time and, once notified, will immediately destroy the relevant data, and cancel the player's registration. A copy of the Club’s Data Protection Policy is available on this website.

Medical Release and Authorization

By completing this form, it is agreed you/your child can receive emergency medical treatment (which may include medication, anesthetic or blood transfusion) as considered necessary by the medical authorities present. In addition, as Parent and/or Guardian of the named player, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named player. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorisation is granted only after a reasonable effort has been made to reach me.

Permission is also granted to RKFC. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorised on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorising medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND CLICKING SUBMIT, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.