Sign On Form - Juniors

Sign On Form - Juniors
Barham Athletic Football Club

Application to register for Barham Athletic FC for the 2019/2020 season.
Team*
Players Full Name*

First NameLast Name
DOB*

DayMonthYear
Home Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Please complete for Parent / Guardians
Parent/Guardian - 1*

First NameLast Name
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Phone Number*

Area CodePhone Number
Parent/Guardian - 2

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Phone Number

Area CodePhone Number
Additional Emergency Contact
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Mobile Number
Relationship With Child
We may from time to time publish photographs of team members on Facebook, Twitter or the Barham Athletic FC website, we need your permission to do this. Please check as appropriate.
Photography

I agree that photographs of the above player may be published on the clubs above mentioned media channels.
The responsibility of the football club for the above named player will commence from the moment he / she arrives at the training / match location and makes themselves known to the coach / manager and ceases when he / she leaves the training / match area after the session.
The player will make their own way to training / matches.The player will be brought to training / matches by a responsible adult.
We undertake as members of Barham Athletic Football Club to at all times conduct our behaviour in accordance with and abide by the rules and regulations of the Barham Atheletic Football Club codes of conduct as laid out by the F.A.

Please note the following in relation to club equipment and policies

1. All equipment provided by the club to players in order to participate "the kit" remains the property of the club and must be returned when requested or when the above player leaves the club

2. Any and all fines levied by the F.A against the above player, regardless of whether the club has paid the fine already, will be paid for by the fined player or their parents and where the club has already paid the fine will be reimbursed within 30 days of the fine being recieved. Non payment of fines will result in the above player being inelligable for selection.

3. As a prerequisite of joining Barham Athletic Football Club I/we agree to adhere to the clubs codes of conduct (which can be found in our Welcome Pack, avilable to download by clicking on the following link Youth Welcome Pack) regarding the behavour of all children, family members and guests associated with the above named child.
Players Signature*
Parent / Guardian Signature*
Medical Information
Next Of Kin
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Phone Number*

Area CodePhone Number
Mobile Phone
Doctors Details
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Phone Number*

Area CodePhone Number
Allergies Or Illness Information / Current Medication *
If it becomes necessary for the player above to receive medical treatment or first aid and I cannot be contacted by telephone or by any other means to authorise this I herby give my general consent to any necessary medical treatment or first aid and authorise the manager / coaching staff to sign any document on my behalf.
Parent / Guardian Signature*
Ways To Pay
Barham Athletic FC prefers BACS as your payment method. You can also send a cheque to the club if you cannot send via BACS.
Please Select Payment Option*

Single payment of £110Two payments (one of £65 and one of £45)
Please ensure that all payments are received by 31st July 2019 to ensure that your child can be registered and play for Barham Athletic FC.

If you are paying in two instalments, please ensure you also enclose the second cheque payment dated 1st December 2019 or for BACS, please ensure your bank is instructed to make the second payment on 1st December 2019.

BACS Payments

Please send payments via BACS to

Barham Athletic FC

Account Number : 31446060

Sort Code : 30-96-26

And include the players name or registration ID from this form as a reference (ID is given on confirmation page).

OR

Send a cheque made payable to Barham Athletic FC to

Barham Athletic c/o Michael Hubert

1 Birds Garden Cottage

East End Lane

Stonham Aspal

IP14 6AS

Unpaid signing on fees will incur an administration charge of £10. Players will be suspended until fees for the season and the administration charge have been paid in full.

All payments are non-refundable.
I consent to receiving a confirmation email from Barham Athletic FC.
Should be Empty:

Sign On Form - Juniors

Barham Athletic Football Club

Medical Information

Ways To Pay