Taster Session Form - Leighton Corinthians YFC

Player's Full Name*

We have read and agree to the Player & Parent Respect Agreement form. This form is available on our club website information section.

https://www.leightoncorinthians.co.uk/information/player-parent-respect-agreement-form

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.

Address*

Postcode*

Primary Contact Name*

Primary Email Address*

Primary Phone Number*

Secondary Contact Name*

Secondary Email Address*

Secondary 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

Player's Signature*

Date*

Date

Parent / Guardian's Signature*

Date*

Date

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