Registration and Medical Form

At Chickerell United Youth FC, we are proud to offer youth football to all regardless of ability.  We endeavor to keep the annual subscription as low as possible.  In order to supplement the subscription and to provide special events, from time to time we will carry out fundraising activities and encourage players and their families to take part.  Your team manager will provide more details when they occur and request assistance from parents and/or players at the time. 

If you would like to join the management committee to help with the running of the club please contact the secretary, at chickerellyfc@gmail.com. 

New members are always welcome!

Team selection *

• U7 Team
• U8 Team
• U9 Team
• U10 Team
• U13 Team
• U16 Team

Parent Emergency Contact Details *

First

Last

Address *

Date of birth *

Contact information *

First

Last

Child Name *

First

Last

Address (only if different from Parent's / Guardian address)

Date of birth *

MEDICAL DETAILS – Name of Doctor *

Doctor's Address *

Doctor's Telephone *

Allergies (e.g. Plasters, Medicine, etc) *

Significant Medical Conditions (e.g. Diabetes, Asthma, etc) *

Please provide written medical instructions to the team coach if your child needs medication. If you have any concerns about a child’s welfare or wish to report an incident, please report to the club Child Welfare Officer at: cufcwelfare@yahoo.com

Declaration of Parent / Guardian *

• I give my persmission for my child to receive any medical treatment whilst with the team
• I agree that my child is fit to participate in football and agree to the Code of Conduct, which can be found
• I agree that photographs may be taken at matches strictly in accordance with the FA guidance
• I acknowledge that any kit supplied by the club will be returned if requested or if any player ceases to be a member of the club. I agree to reimburse the club a sum of £50 if the kit is not returned due to loss or damage
• I understand and agree that the data from this form will be held for Club purposes ONLY

Signature and Date *

Please provide your full name and date. By doing so, it will be considered as your signature and your confirmation that all the information provided above is correct

Submit

Annual Subscription £150 (£30 to be paid with this registration form in July; £30 by 30 September; £90 by 31 December).

Nat West Bank: Chickerell United YFC Sort code: 60-23-35 Account Number: 71368906

Club Secretary: Mr. Tony Elliot. Tel: 07584 598142