FC Peterborough Girls Football Registration Form
Every Saturday 10:30 - 11:30am, ages 6+, open to all, starting Saturday 20th June
Player Details
*
First Name
Middle Name
Last Name
Player Date of Birth
*
Which school does the player attend
*
What school year is the player in
*
Parent / Guardian
*
First Name
Last Name
Relationship to Player
*
Father
Mother
Guardian
Other
Address
*
Street Address
Street Address Line 2
City
County
Post Code
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Email
*
example@example.com
Print Name
*
Signature
*
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Player Medical History
FC Peterborough
1 - Parent / Guardian Emergency Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
2 - Parent / Guardian Emergency Contact Name
*
First Name
Last Name
Telephone Number
*
Please enter a valid phone number.
Format: 00000000000.
Has the player had in the past or does the player currently have any of the following? (Tick any that apply)
*
Anemia
Asthma
Diabetes
Epilepsy/Seizures
Fainting Spells
Heart Disease
Heart Attack
High Blood Pressure
Kidney Disease
Liver Disease
None
Other
If you answered Yes to any of the above, please provide details below
Does the player suffer from any other allergy?
*
Yes
No
None
If you answered Yes to the above, please provide details below
Please share any other details or medical conditions we need to be aware of
FC Peterborough
Millfiled Auto Parts Arena
Chestnut Avenue
Peterborough
PE1 4PE
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