Childs First Name
*
Child's Last Name
*
Child's D.O.B
*
Email
*
Phone
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Relationship to child
2nd Emergency Contact Name
*
2nd Emergency Contact Phone Number
*
Please list any medical or other important information here…
I give permission for the player’s name to be published.
Yes
No
Data Protection - I accept the Data Protection Privacy Policy Key Privacy Statement and agree to St Leonard’s Juniors Football Club holding the personal data of the named player (when under the age of 18) on their secure database and to use the data appropriately for football related purposes within the Football Club and with external third-party organisations.
*
Yes
No
I give permission for film and/or photographs to be taken of the named player.
*
Yes
No
Filming & Photography - the club may film or take photographs that may be published or shared. The club requires consent from the individual (if over 18) or the individual’s Parent/Guardian where under 18. The Club adheres to GDPR and FA Guidelines to ensure photographs and films are used solely for the purposes for which they are intended, which is the promotion and celebration of football.
*
I understand this statement
I don't understand this statement
Medical Consent - in the event that the named child is injured whilst playing football or travelling to and from football events and I cannot be contacted on the above number, I hereby give my consent for the named child to receive medical attention.
*
Yes
No
I agree to
terms & conditions
provided by the company. By providing my phone number, I agree to receive text messages from the business.
Submit
