POWERCHAIR FOOTBALL REGISTRATION FORM

Player first name

Player surname

Email address

Mobile number

Players Address inc Postcode

Players date of birth

Day

Month

Year

Players disability/condition

Any other information that may help us to help you - including communication with player if applicable

Name of emergency contact and their relationship to the player

Phone number of emergency contact

Recent head and shoulders photo of player

I agree to participate in Lancashire Spitfires organised events and activities and agree to adhere to guidelines and codes of conduct that may be issued in the interest of my own safety. Signed by player/guardian

Signature field is empty.

Parents’ & Lead Carers’ Agreement (Parent/Lead Carer also signs this if player is 18 or over) I have read and understood the Parents’ & Carers’ Code of Conduct laid down by Lancashire Spitfires and the FA and agree to behave in an appropriate manner.

Signature field is empty.

Adult Players’ Agreement I have read and understood the Adult Players’ Code of Conduct laid down by Lancashire Spitfires and the FA and agree to behave in a manner that supports and displays these guidelines. Player signs if over 18.

Signature field is empty.

I give consent for my photo to be used online/social media representing the club

Yes

Date of submission of form

Day

Month

Year