Women's Senior Team - Trial Registration Form 25/26
Walton & Hersham Football Club
Players Full Name
*
Players First Name
Players Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Current Age
Date Available to Attend
Wednesday, 16th July 2025
Wednesday, 23rd July 2025
Wednesday, 30th July 2025
Players Email Address
*
example@example.com
Players Contact Number
*
Please enter a valid phone number.
Primary Playing Position
Secondary Playing Position
Previous / Current Playing Club
Previous / Current Playing League
Emergency Contact Details Name
*
First Name
Last Name
Emergency Contact Details Tel
*
Please enter a valid phone number.
Does the player suffer from any of the following? (select all that apply)
*
Asthma/Bronchitis
Heart Condition
Anaemia
Diabetes
Fits/Fainting/Blackouts
Severe Headaches/Migraines
Food Allergies
None of the above
Other
If you answered yes to food allergies, please provide details.
Does the player normally carry medicines/drugs or an inhaler?
*
Please Select
Yes
No
If you answered 'Yes' to a medicines/drugs, please provide details.
Is the player currently being treated for a medical condition?
*
Please Select
Yes
No
If you answered 'Yes' to a medical condition, please provide details.
Has the player been given any specific advice in the event of an emergency?
*
Please Select
Yes
No
If you answered 'Yes' to a event of emergency, please provide details.
Do you consent to the player being given Paracetamol?
*
Please Select
Yes
No
If applicable, please provide any other medical information that the Club should be aware of.
Submit
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