Southgate Player Registrations – Southgate Colts FC

Southgate Player Registrations Form

IMPORTANT INFORMATION:

Please be aware that by giving your online consent by completing the form below you are agreeing to:

The registration of this player and the club storing this information
Our qualified coaches and personnel, in cases of serious illness or injury, to act in loco parentis if we were unable to contact you, including taking your child to hospital, giving permission for medical treatment and giving the information listed above to medical staff
The player and parental expectations set out in the codes of conduct attached to the email.

ALL INFORMATION DISCLOSED WILL BE TREATED WITH THE UTMOST CONFIDENTIALITY

Southgate Football Club only holds data on players and parents solely for the running of the club and its activities. All data is held by the club secretary and manager in a secure manner. Data is only shared within the club, relevant football leagues and the FA. Please contact the club secretary if you wish for further details.

Before completing the online registration you will need to upload a profile photo of your child. Please no full body photos as these will then need to be cropped.

These photos will only be used to upload to the FA website to register your child.

Please send these photos via email to – hooper_shane@yahoo.co.uk along with the child’s name.

Southgate Colts Online Player Registration Form 2020/21

This form is for use to send a player registration request to Southgate by parents or carers. Do not use this form if you have not contacted or spoken to your child’s manager or Southgate Secretary. You should only use this form if you have been asked to do so.

Player Name: *

First

Middle

Last

Enter the players names here

Main Address *

Enter the players main home address

Post Code *

Please enter your main address post code

Current School *

Please enter your child’s current school

Parent / Carer Name (Main contact) *

First

Last

Enter the parent or carers name, must be the main contact.

Parent / Carer Contact number *

Please enter a contact telephone number

Parent / Carer Date of Birth *

Please enter parent / carer date of birth. (This is required to register parental contact details on the FA online registration systems)

Second Emergency Contact Name *

First

Last

Enter the second emergency contact name

Second Emergency contact number

Please enter second emergency contact number

Players Doctors Name *

Please enter the players doctors name

Doctors Address *

Enter the doctors surgery address

Doctors Telephone number

Please enter doctors surgery contact number

Do you consider your child fit and capable of taking part in all activities expected of football training and competitive matches? Yes or No *

Yes or No Only

Does your child have any health or behavioural problems which require medication? Yes or No *

Yes or No Only

If yes to the above, please state *

Please state details if required or if not please input N/A

Medication taken / dosage / time to be taken? *

Please state details if required or if not please input N/A

Is your child allergic to anything? If yes, please give details *

Please state details if required or if not please input No.

When was your child's last tetanus injection? *

Please give date if known / or enter ‘up to date’ if that is the case

Has your child ever suffered a serious injury which needs to be brought to the club's attention ie. broken arm/leg? If yes, please give details *

Give details if required, if not input No

Any other relevant information you feel would be helpful to us and your child whilst at Southgate Football Club? *

Please add any comments here.

I ALLOW Permission for Southgate Colts to photograph/video my child as named above and use on club social media where appropriate. Yes / No only *

Input Yes or no only

Phone