2023 - 2024 Registration Form - Leighton Corinthians YFC

Player's Full Name*

I (The Player) agrees to become a member of Leighton Corinthians Youth Football Club ( “the club” )I agree to abide by the rules and regulations and to uphold the sporting tradition of the club.The following information is required by the Club’s Secretary to comply with the requirements of the various sports representative bodies such as the Football Association and the MKDDL to whom this information may be supplied.

Player's nationality*

Address*

Postcode*

Primary Contact Name*

Primary Email Address*

Primary Phone Number*

Secondary Contact Name*

Secondary Email Address*

Secondary Phone Number*

Third Contact Name*

Third Contact Email Address*

Third Contact Phone Number*

Players Date of Birth*

Players Date of Birth

Players Gender*

Age Group ( Please select from dropdown list )*

Medical History - Does the above named child have any Medical Conditions / Allergies of which the club should be made aware of?*

If yes, please provide information

I understand that whilst all reasonable care will be taken with the child named above during their activity within the club, in the unfortunate event of any medical emergency I DO / I DO NOT consent to medical treatment being given.

I DO
I DO NOT

Permission to use child's name and photographs. Player's name and photographs maybe reproduced e.g on the club's website or social media platforms

I DO
I DO NOT

Please read and sign the following statement. "In the event that I ( the parent / guardian ) am unable to transport my child to a team football match / training session, I give permission for another team members parent / guardian / adult ( known to me ) to transport my child ( Excluding club officials)"*

Player Head Shot Photo ( New and existing players )*

New players joining the club will also need to supply a copy of a birth certificate or passport. This will be retained by the club for league registration purposes.

New players joining the club will also need to register with the FA by creating a FAN number. This is needed to be able to register your son/daughter to play league matches. Please see our information page - https://www.leightoncorinthians.co.uk/information/creating-a-fan-number-with-the-fa-new-players

The FA also require 1 x PARENT of each player to have a FAN number. If you don't already have one, please use the link above to register. Please complete the box below with the FAN number*

Full Name used on FAN Number Regisitration*

DOB used for FAN number registration*

DOB used for FAN number registration

SUBSCRIPTIONS AND PAYMENTS

A minimum 50% deposit is required by 1st July 2023.

Balance to be paid in the following way

3 monthly staged payments via standing order / Bank Transfer on the following dates ( Please note we will not be accepting cash or cheques )

15th Aug

15th Sept

15th Oct

EXAMPLE OF STANDING ORDER / BANK TRANSFER

Total subscription of £150

Deposit paid (£75 / July) = £75 balance

Paid in 3 monthly instalments of £25

You can set up a standing order / Bank Transfer via online banking, using the following details:

Name of person you are paying: Leighton Corinthians

Sort code: 53-70-11

Account Number: 07686579

Payment Reference: Please use your child's age group and their initials

( Example U14MK)

Payment Reference*

CURRENT YEAR SUBSCRIPTION

Under 6s £75.00

Under 7s to Under 11s £150.00

Under 14s to Under 16s £190.00

Under 18s. £210.00

Younger playing siblings receives a 50% discount on these fees.

(Limited to 1 discount per family)

Fees are based on a football season which runs from 1st September to 31st May and does not include any summer training

Player's Signature*

Date*

Date

Parent / Guardian's Signature*

Date*

Date