Arena 03 Kilifi League & Football Camps Registration Form

Player Information

Player's Name

First NameLast Name

Birth Date

MonthDayYear

Age Group

Gender

MaleFemale

Parent/Guardian Information

Name*

First NameLast Name

Mobile Number*

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Does the player have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the player prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby provide my consent for my child's participation in all activities organized by Arena 03 Kilifi Kids Leagues and Football Camps during the chosen league times and camp sessions. By accepting my child's participation, I acknowledge and accept all the potential risks and hazards associated with these activities. I release, exempt, and indemnify Arena 03 Kilifi & Bofa Football Academy and all its officials, representatives, and agents from any responsibility for injuries that may occur to my child during their travel to, engagement in, or return from the sessions.

If my child sustains an injury, I waive any claims against Arena 03 Kilifi & Bofa Football Academy, including its coaches, affiliates, fellow participants, supporting organizations, advertisers, and, if applicable, the owners and landlords of the premises where the event is held. Engaging in sports activities, including soccer, inherently carries a risk of injury, which may include but is not limited to fractures, paralysis, or even fatality.

Medical Release and Authorization

As the legal guardian of the youth athlete listed, I hereby grant permission for qualified and licensed medical professionals to diagnose and administer treatment in the event of a medical emergency. This authorization is applicable when, in the medical professional's judgment, immediate attention is necessary to prevent further harm to the minor child's life, physical appearance, physical functionality, or to alleviate undue pain, suffering, or discomfort should there be a delay in treatment.

I hereby give consent to the attending physician to undertake any necessary medical or minor surgical procedures, conduct X-ray examinations, and administer immunizations to the youth athlete named. In cases of a serious illness, the requirement for major surgery, or significant accidental injury, I am aware that the attending physician will make every reasonable effort to contact me as swiftly as possible before proceeding with treatment. This authorization is granted after a reasonable attempt has been made to reach me.

I also authorize the affiliated individuals, including Directors, Coaches, and Team Parents, to provide essential emergency treatment before the child is admitted to a medical facility.

This consent is valid during the dates and for the duration of the registered season. I willingly provide this authorization to ensure prompt medical treatment under emergency circumstances, safeguarding the life and well-being of the named minor child when I am not present.

LEAGUE REGISTRATION REQUIREMENTS & FEES

You will need to fill out one registration per child. Once you have completed the regsitration and payment you can start a new registration form for the next child. Please review the requirements below before you proceed:

1. League Fees: Kes. 1,250/- per month in advance or full payment Kes. 3,750/-. (RENEWS EVERY).

2. Parent/Guardian Consent Form: Required for all age groups, signed before the first session.

3. Medical Clearance: A letter or certificate from a medical professional stating the child is fit to participate in sports activities.

4. Kit Requirements (Optional for League players but recommended):

- Essential: Comfortable sportswear (t-shirt, shorts, socks), football turf shoes (NO STUDS allowed when playing at Arena 03 Kilifi), shin guards.

- Branded Academy Kit: Includes 2 full kit sets (jersey, shorts, socks) at a package cost of Kes. 4,000/- per member. This kit is recommended for all members.

PAYMENT DETAILS & CONFIRMATION

Pay to: ARENA 03 KILIFI

Paybill: 880100

Account Number: 800303#(Names of player)

Please send payment confirmation message and player name to +254758 42 42 47 or email arena03kilifi@gmail.com

Fill out one registration per child. Once you have completed the regsitration and payment you can start a new registration form for the next child. Please review the requirements below before you proceed