Rising Stars - Parental Consent Form

Welcome to Rainhill United Junior Football Club

Thank you for choosing to be part of our club. We hope you quickly feel part of the team and enjoy your time here. Once you have filled this form in you will receive copies of key club policies. They are available to view here https://www.rainhillunited.co.uk/club-documents-4/ - These policies have been written so everyone in the club gets as much enjoyment out of grassroots football as possible.
Child's Full Name*

First NameMiddle NameLast Name
Gender*

MaleFemale
Date of Birth*

DayMonthYear
Calculate Age
Address*

Street Address

Street Address Line 2

City

Postcode
Additional Player Information
Have you any other children at the club?*
Other child Name:*
Player Medical Information
Details of any known allergies, conditions, medication being taken.*
Please insert NA if none known
Any other special needs, requirements or directions that manager needs to be aware of. NA if none*
Please insert NA if none known
Does your child require glasses to play sport ?*

YesNo
GP Surgery Player is registered to (not doctor's name):*
Name of GP Surgery if not on list:*
Parent / Guardian Information
Contact 1 Name:*

First NameLast Name
Contact 1 Relationship to Player:*
Contact 1 Date of Birth:*

DayMonthYear
New FA requirement need DOB of adults of U18 players
Contact 1 Mobile Number*
Contact 1 E-mail:*
Contact 2 Name (Alternative Emergency Contact):*

First NameLast Name
Contact 2 Relationship to Player:*
Contact 2 Date of Birth:*

DayMonthYear
New FA requirement need DOB of adults of U18 players
Contact 2 Mobile Number*
Photograph of Child (Passport style photo only - Head shot only)
Head shot only Photo Upload*

Upload a File

Cancelof
Informed Consent and Acknowledgement
I will inform the coaches of any important changes to my child’s health, medication or needs and also of any changes to our address or phone numbers provided.*

YesNo
In the event of illness, having parental responsibility for the above named child, I give permission for medical treatment to be administered where considered necessary by a nominated first aider, or by suitably qualified medical practitioners. If I cannot be contacted and my child should require emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency medical treatment. *

YesNo
I confirm all details above are correct to the best of my knowledge and I am able to give parental consent for my child to travel to and participate in all activities.*

YesNo
I give permission for my child’s image to be used, as appropriate, on the Club Website and social media platforms under the guidance of FA directives on child protection.*

YesNo
Confirmation

BY AGREEING ABOVE AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Electronic Signature:*

I agree with the information above to be submitted
The Contents of this Submission are valid and correct for the 2025/2026 Season:

I have reviewed and confirm contents are correct
Signed by:*
Your Relationship to Player:*
Today's Date:*

DayMonthYear
Date & Time of Original Consent Form Completion:

DayMonthYear
DateHourMinutes
Trainer Only
Left club

Yes
Leave Date

MonthDayYear
Date
Should be Empty:

Welcome to Rainhill United Junior Football Club

Additional Player Information

Player Medical Information

Parent / Guardian Information

Photograph of Child (Passport style photo only - Head shot only)

Informed Consent and Acknowledgement