West of Scotland Junior Registration and Payment Form 2023/24
Child's Name
First Name
Last Name
Child's Date of Birth
Child's Address
Street Address
Street Address Line 2
City
State / Province
Post Code
Parent/Guardian's Full Name
First Name
Last Name
Parent/Guardian's Phone Number - Home
Parent/Guardian's Phone Number - Mobile
Parent/Guardian's E-Mail Address
Emergency Contact's Name
Emergency Contact's Phone Number - Home
Emergency Contact's Phone Number - Mobile
School Attending
Child's School Year
Please Select
P1
P2
P3
P4
P5
P6
P7
S1
S2
S3
S4
I consent to photo and video images being collected on the pitch for the club website and social media channels.
*
YES
NO
I consent to First Aid being administered to my child on the pitch, if deemed necessary by their coaches.
*
YES
NO
Membership Type (one selection must be selected)
prev
next
( X )
Family Membership - (2 Adults + 2 Playing Children U16)
£
275.00
Can add futher children below
Family Membership - (2 Adults + 1 Playing Child U16)
£
180.00
Additional Playing Child (Added to the 2 + 2 Family Membership) -
£
75.00
Junior Playing Mini
£
135.00
P1 - P7
Junior Playing Midi
£
160.00
S1 - S4 (U-13 to U-16)
Girls (U16)
£
135.00
Additional Child Details
£
Free
Please select when adding details for a child you have already paid for in a previous submission.
Quantity
1
2
3
4
5
6
7
8
9
10
Total
£
0.00
If you require an additional child to be added to your Family Membership, please complete another form. Records are required for each individual child. Thank you.
Does you child have any medical conditions
Please Select
YES
NO
If YES please provide details
Does you child have any allergies
Please Select
YES
NO
If YES please provide details
Please click SUBMIT below to submit your Registration form and make payment. Payment is taken via PayPal - you do not need a PayPal account in order to make payment - just Credit or Debit card details.
Submit
Should be Empty: