Player Information & Payment (Pay & Play) - NEW PLAYERS
Please complete this form ahead of your child attending their first Pay & Play session with Haverfordwest County AFC.
Parent/Guardian Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Emergency Contact Number
*
-
Area Code
Phone Number
Back-Up Emergency Contact Number
*
-
Area Code
Phone Number
Child Full Name
*
First Name
Last Name
Child Date of Birth
*
-
Month
-
Day
Year
Date
Child Age
*
Please Select
5
6
7
8
9
10
11
Disability
*
Please Select
Yes
No
Prefer not to say
If you answered yes to the question above, please provide details of the disability, along with how club staff can best support your child
Gender
*
Please Select
Male
Female
Other
Does your child suffer from any medical conditions/allergies that staff should be aware of? If yes, please provide details below
*
In the event of an accident or illness, I authorise Haverfordwest County AFC to take any necessary action
*
Please Select
Yes
No
I consent to Haverfordwest County AFC taking photos and videos of my child for the use of social media and advertisements
*
Please Select
Yes
No
I consent to being added to Haverfordwest County AFCs' mailing list
*
Please Select
Yes
No
Payment Information
*
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( X )
Pay & Play Payment
£
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: