Your Registration Data



Player Section


Team Age Group Under 15
First Name [44]
Surname [45]
Fan number if Registered 67566446
Date of Birth 22nd December 2009
Mobile Number N/A
Email [48]

116 Perry Rise

Post Code SE23 2QP
School Therfield
School Post Code KT22 7NZ
Previous Club Dulwich Hamlet Junior FC U14



Parents Section


Parent/Carer Parent
First Name [60]
Surname [61]
Date of Birth [126 format=”jS F Y”]
Fan number if Registered 67696890
Mobile Number 07973 235562
Post Code



Medical Section


Does the player have any allergies or medical conditions YES
If so please state here

Mild asthma and hayfever (both summer only)

Is the player taking medication YES
If so please state here

ventolin, becotide and anti histamine

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 27th December 1977
Fan number if Registered N/A
Mobile number 07522 675924



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
[60] [61]

(Parent of [44] [45])