Chester FC Football Education Assessment Registration

1
Player Name* This field is required.
First Name
Last Name
2
Date of Birth* This field is required.
Date
Day
Month
Year
3
Responsible Adult* This field is required.Please provide the name of a parent or responsible adult for the above child.
First Name
Last Name
4
Emergency Contact Number* This field is required.Please provide a contact mobile number for the responsible adult in case of emergenices.
Area Code
Phone Number
5
Email* This field is required.Please provide a contact email address
example@example.com
6
Please select which dates you would like to attend* This field is required.You are welcome to attend as many of the sessions as you wish
Tuesday 29th July (12pm-1.30pm)
Tuesday 5th August (12pm-1.30pm)
Tuesday 12th August (12pm-1.30pm)
Tuesday 19th August (12pm-1.30pm)
7
Playing History* This field is required.Please outline your previous playing experience, including any clubs, teams or academies you have played for, with dates and age groups where possible.
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Small
Ok
Ok
8
Position* This field is required.Please list your preferred positions.
9
Medical InformationPlease detail any allergies or medical conditions coaches may need to be aware of.
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Normal
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Ok
Ok
10
Photographic Consent* This field is required.Do you consent to Chester FC Community Trust photographing or videoing the above child’s involvement in activities to publicise or promote the charity or as a coaching aid?
YESNO
Should be Empty: