Driffield Junior Football Club

Players Application Form – Season 2007/08

Full Name: ________________________________________________________

Address: ________________________________________________________

______________________________ Postcode__________________

D.O.B: ________________________________________________________

Nationality: ________________________________________________________

School: __________________________________ School Year: __________

Age Group: Minis/U8/U9/U10/U11/U12/U13/U14/U16/Ladies Boys/Girls

(please circle)

Please specify any medical condition that the club should be aware of e.g Asthma,

Epilepsy etc.

_____________________________________________________________________

Parent/Guardian Details

Full Name: _________________________________________________________

Tel No: _________________________________________________________

Mob No: _________________________________________________________

Email: _________________________________________________________

Please give a second contact in the event we can not contact you

Full Name: _________________________________________________________

Tel No: _________________________________________________________

Mobile: _________________________________________________________

Parental/Guardian Consent :

I agree to be bound by all of the Club and FA Rules and Regulations.

I agree to pay the current club membership fee of £35.00 (cheques made payable to ‘Driffield Junior Football Club’).

Should my son/daughter be injured whilst playing or travelling to/from football events and I can not be contacted on the contact numbers given, I hereby give my consent for my child to receive medical aid.

Signed: ___________________ Please print name: __________________ Date: ____________

I agree to my son/daughter having his/her photograph taken during the 2007/08 season and for possible inclusion on the club website.

Signed: ___________________ Please print name: __________________ Date: ____________

Applications for the minis are free to join but a payment of £1 is payable each time your child plays.

This form must be completed and returned to your coach every season in order for your child to play