Player Section
Team Age Group | Under 15 |
First Name | [44] |
Surname | [45] |
Fan number if Registered | 00000001 |
Date of Birth | 1st June 2011 |
Mobile Number | na |
[48] | |
Address |
th e hill |
Post Code | se99 999i |
School | the hill |
School Post Code | school |
Previous Club | southwark |
Parents Section
Parent/Carer | Parent |
First Name | [60] |
Surname | [61] |
Date of Birth | [126 format=”jS F Y”] |
Fan number if Registered | 000001 |
Mobile Number | 999099900 |
secretary@dulwichhamletjuniorfc.co.uk | |
Address |
12 Watlington Grove |
Post Code | SE26 5RR |
Medical Section
Does the player have any allergies or medical conditions | YES |
If so please state here |
hayfever |
Is the player taking medication | YES |
If so please state here |
pills |
Is layer OK to administer medication unsupervised | NO |
If no, then suitable advice to be supplied to the team manager |
yes |
Supply another emergency contact and number | |
First Name | [77] |
Surname | [128] |
Relationship to player | Mother |
Date of Birth | 1st January 1950 |
Fan number if Registered | n/a |
Mobile number | 887881010 |
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. |
|
I agree to the conditions stated above and that all the information provided is correct. | YES |
[60] [61] (Parent of [44] [45]) |