Your Registration Data

 

 

Player Section

 

Team Age Group Under 13
First Name [44]
Surname [45]
Fan number if Registered 68899531
Date of Birth 13th March 2014
Mobile Number NA
Email [48]
Address

46 Elfindale Road
Post Code SE24 9NW
School Charter School North Dulwich
School Post Code SE24 9JH
Previous Club Dulwich Hamlet Junior U12 Pink

 

 

Parents Section

 

Parent/Carer Parent
First Name [60]
Surname [61]
Date of Birth [126 format=”jS F Y”]
Fan number if Registered 64303256
Mobile Number 07545 178671
Email stephenlennard@gmail.com
Address
Post Code

 

 

Medical Section

 

Does the player have any allergies or medical conditions NO
If so please state here
Is the player taking medication YES
If so please state here

Insulin
Is layer OK to administer medication unsupervised YES
If no, then suitable advice to be supplied to the team manager
Supply another emergency contact and number
First Name [77]
Surname [128]
Relationship to player Mother
Date of Birth 30th October 1980
Fan number if Registered NA
Mobile number 07708 166642

 

 

Agreement and Confirmation Section

 

It is a condition of a player joining Dulwich Hamlet Junior FC that the player and parents, guardians, carers, family and supporters of that player, agree to be bound by the club rules and to abide by our club’s Code Of Conduct at all times.

A signing on fee of £50 is payable on completion of this form and can be paid using our secure online payments portal with Paypal which appear automatically when the registration form is submitted.

A fee of £8.00 is due weekly and is to be paid monthly – £32.00 – for a period of eight months only. This is to be set up at the same time as the signing on fee is completed using our secure online payment portal with Paypal.

Any subsequent brothers or sisters joining the club in the same season as players will be entitled to a £15.00 discount on the signing on fee.

Complete the payment boxes as usual for any siblings and on confirmation of that by the manager’s, the club will refund the difference direct to the person who made the payment.

Training – All training subs will be collected by the team manager and should never be paid direct to the club.

It is also a condition of joining the club that all club functions/fundraisers will be supported by all.

I agree to the conditions stated above and that all the information provided is correct. YES
28/06/2026
[60] [61]
(Parent of [44] [45])