Ladies Membership Form COALVILLE TOWN YOUTH TEAMS SIGNING ON FORM Player Details Player Name (required) Player DOB (required) Player Nationality (required) Player Country of Birth (required) Player Address (required) Player Address Post Code (required) Coalville Town Team Signing On: Open Ladies Ravenettes Emergency Contact Details Emergency First Name (required) Emergency Surname Name (required) Emergency Phone No. (required) Emergency Email Address (required) Second Emergency Contact Name (required) Second Emergency Contact No (required) Second Emergency Relationship to Player (required) Medical Conditions Details Does the player signing on have any medical conditions ?(required) YesNo if Yes, please fill in below details; Medical Condition; Doctors Name (required if Yes) Doctors Address (required if Yes) Doctors Phone No (required if Yes) Player ID Birth certificate, passport Only required if player has not previous played for Coalville Town Youth FC Player Photo Digital Photos must not; contain no other objects or people be taken against a plain light-coloured background be in clear contrast to the background not have ‘red eye’ If you’re using a photo taken during your application, include your head, shoulders and upper body. PLEASE READ Photographs may be taken of you playing for Coalville Town Youth FC, Please tick if this is acceptable as we may use these photographs for publicity and promoting the club. YesNo We expect your commitment to let your manager know if you cannot attend training or will not be available for any games (giving as much prior notice as possible). We love to send you details about up and coming events,offers and the latest info from Coalville Town Youth Football Club by email, SMS and other electronic means. We'll always treat your personal details with the upmost care and never sell them on to other companies for marketing purposes. Yes - PleaseNo - Thanks Membership Terms and Conditions - Read and Understand View Code of Conduct I have read and understood the FA Respect Code of Conduct for Young Players, Spectators/Parents/Carers and the policies of the club and I will follow the Code of Conduct and Club policies at all times.If I do not follow the Code of Conduct and Club policies, I am aware of the possible actions by Coalville Town and the FA Read & Understood If my behaviour causes the club to incur fines then you will deemed liable for the associated costs. Any outstanding debts/fines may cause the player to be inegliable to play for the team until such time debts/fines have been cleared. Read & Understood Payment Monthly Direct Debit Fee £22.00 Preferred Direct Debit Date 1st of each month15th of each monthLump Sum (September to June) I confirm that the information given in this form is true, complete and accurate. Please check your details are correct before submitting this form. Any missing information will hold up registration of player