Soccer School Camps – Coalville Town Youth Football Club

COALVILLE TOWN YOUTH TEAMS SOCCER SCHOOL CAMP

Player Details

Player Name

Player Age
Player DOB 01/01/22

Players Address
Player Post Code

Parents Email

Soccer School

Dates Required

Week One

Monday 16th October
Tuesday 17th October
Wednesday 18th October

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Parent-Guardian Details

Parent Name

Parent/Guardian Details/Emergency Phone No. (required)

Parent/Guardian Details/Emergency Email Address (required)

Second Emergency Contact Name (required)

Second Emergency Contact No (required)

Second Emergency Relationship to Player (required)

Is there any family Members you wish not collect your child (required)

Any impairments - that we need to be made aware of (learning/hearing difficulties)

Any relevant information about their culture or faith that we need to be aware of.

Medical Conditions Details

Does the player have any medical conditions you feel the club need to be aware of?
(required)
YesNo

if Yes, please fill in below details;

Doctors Name (required if Yes)

Doctors Address (required if Yes)

Doctors Phone No (required if Yes)

PLEASE READ

Photographs may be taken of your child 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 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

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

Please check your details are correct before submitting this form.

Payment details will be sent out to the email provided.