Name of Parent
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Parent’s Email Address
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Participant Name
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Address Line 1
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Address line 2
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Address Line 3

Postcode
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Home Telephone Number
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Mobile Telephone Number

Date Of Birth
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7 - 10yrs: 10.30am - 12pm 11 - 15yrs: 1pm - 2.30pm
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Gender

Male Female
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Ethnic Origin

White Chinese Black African Black Caribbean Black Other Pakistani Indian Other Please make a selection.

Please list any Allergies / Conditions / Medication

Full Name
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Telephone Number
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Mobile Number

Full Name
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Telephone Number
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Mobile Number

We are committed through trained and competent staff to providing a safe learning environment, however football is a contact sport and injuries may occur through no negligence of our staff. We feel it is our responsibility to ensure the safety of the attendee by making sure they come well equipped for the activity i.e. correct footwear, appropriate clothing, food/drinks if appropriate, medication (if applicable).

I have read and understood this form, completed all the details requested to the best of my knowledge and will comply with the information set out. I acknowledge and accept that CFC or respective servants shall not have any liability in respect with any loss or damage to property and give permission for my child to receive emergency medical treatment in my absence if deemed necessary.

I give permission for any photo's taken of my child/ren during the course to be used in promotional/ marketing material.