Club Membership Form

CLUB ANNUAL MEMBERSHIP, INFORMATION AND CONSENT FORM

This form is to be completed by the parent/carer and child at the start of each season. It is recommended that this form is completed and signed by the parent/carer and the player at the same time. Parents/carers are responsible for informing the club of any changes as they occur. It is your responsibility to check the measures the club has put in place to manage any risks, including its Covid-19 measures in line with current Government guidance. Providing your consent for your child to return to play from 2022-23 season onward confirms that you understand the activities being offered to your child and agree with the measures that the club has put in place.

Name of child:
Date of birth:
School Year at start of season:

Passport photo of child

Parent’s/carer’s name:

Parent’s/carer’s home address:

Parent’s/carer’s main phone number (please include a number that you can be reached on at any time):

Parent’s/carer’s Email:

If the child is not living with parent(s)/carer)s)/legal guardian(s) please clarify the legal status of the child and his/her current carers. It is important that you fill in the rest of this form as fully as possible. Failure to tell us things could mean that the safety and welfare of your child is compromised. The club cannot be held responsible if information has not been shared.

HEALTH NEEDS

I agree to the club holding the health, medical and/or medication data I have provided below to ensure my child’s safety and to take appropriate action to ensure their wellbeing (tick box to agree, leave blank to disagree). I understand that I can withdraw my consent at any time, though this may result in my child being unable to participate in the club’s activities.

Does your child have any known health needs? e.g. diabetes, asthma, epilepsy, allergies. If so complete the next section:

Current Medication

Name:

Dose:

Frequency:

What does the club need to do to help keep your child well e.g. administer planned medication/call ambulance/give snacks? Please be very specific.What does the club need to do to help keep your child well e.g. administer planned medication/call ambulance/give snacks? Please be very specific.

Do club members need any medical training other than First Aid to care for your child? If yes, please specify.

Does your child have any access needs? If yes, please tell us what we need to do to help him/her.

COMMUNICATION

Does your child have any communication needs e.g. non-English speaker/hearing impairment/sign language user/dyslexia. If yes please tell us what we need to do to enable him/her to communicate with us?

RELIGION AND CULTURE

I agree to the club holding the religion and/or philosophical beliefs data I have provided below to ensure my child's religious needs and beliefs are met and to take appropriate action to ensure their wellbeing. I understand that I can withdraw my consent at any time.

Does your child participate in religion or spiritual practice? Please tell us what it is.Does your child participate in religion or spiritual practice? Please tell us what it is.

What do we need to know to ensure your child’s preferences/needs are met e.g. are there any dietary guideline/dress codes we need to follow or support?What do we need to know to ensure your child’s preferences/needs are met e.g. are there any dietary guideline/dress codes we need to follow or support?

IMAGES/FOOTAGE

At times throughout the season the club may wish to take photos or videos of the team or individuals in it. We adhere to The FA Guidelines to ensure these are safe and respectful and used solely for the purposes for which they are intended, which is promotion and celebration of the activities of the club and for training purposes.

I confirm that my child is not subject to any family, care or legal proceedings which would impact the ability of the club to take photos or videos of my child and, if photos or videos were taken, that would not adversely affect the safety of my child. (Tick box to agree, leave blank to disagree)

I agree to the club being able to use photos and videos taken during this season of my child, to be used on social media and/or the club website. I understand that I can withdraw my consent for this at any time during the season by notifying the club. (Tick box to agree, leave blank to disagree)

PERMISSION OF PARENT/CARER

I give permission for my child to participate in the Football Club’s events and agree to the conditions outlined above. I accept that it is my responsibility to inform the club directly of any changes to the details recorded on this form.

Signed by parent/carer:

Name of parent/carer:

Date:

PLAYER’S AGREEMENT

I will take part in football activities as detailed in this form and agree to adhere to the club’s rules and any guidelines and or codes of conduct that may be issued in the interest of my own safety.

I will tell the coach or another person if I do not feel well or if I have any worries.

Signed by Player