Drayton Grange Football Club
Supporting Youth Football in Daventry Town since 1976

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Parental Consent For Football Activities.

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Registration Form

Players Details

First Name

Last Name

Date of Birth

Age Group

Team Name

Details of football activity.

The participation in games, training and social activities. I agree to John Smith taking part in this activity. I agree to their participation in the activities described. I acknowledge the need for them to behave responsible.

Medical information about your child.

Any conditions requiring medical treatment, including medication?

Yes

No

Please give details.

To the best of your knowledge, has your son/daughter been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may be contagious or infectious?

Yes

No

Please give details.

Is your son / daughter allergic to any medication?

Yes

No

Please give details.

Does your son/daughter suffer from any other allergies, such as food types?

Yes

No

Please give details.

Has your son/daughter had a tetanus injection?

Yes

No

Date of last tetanus.

Declaration

I will inform the person in charge as soon as possible of any changes in the medical or other circumstances between now and the end of the season,

I agree to my son/daughter receiving medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present. I understand the extent and limitations of the insurance cover provided.

I agree to my son/daughter receiving first aid treatment from any member of the Drayton Grange coaching staff qualified to do so.

I agree to my son/daughter having their photograph taken during matches and possibility used on the www.draytongrange.net website.

Yes

No

Main Contact

Title

Other Title

First Name

Last Name

Home Phone Number

Mobile Phone Number

Work Phone Number

Address

Email Address

Secondary Contact

Title

Other Title

First Name

Last Name

Home Phone Number

Mobile Phone Number

Work Phone Number

Address

Email Address

By submitting this form, players and parents/carers agree to abide by Drayton Grange Football Club's Code of Conduct. Please retain your copy of the Code of Conduct for future reference. If there are any other details not covered in this form, which you feel we should be made aware of, or you have any concerns or comments, please speak to a member of the coaching staff or committee.

This is an abbreviated version of our full data privacy notice which is available on request or from our website. We may process yours and your childs personal data in order to administer memberships, and provide membership services you are signing up to when you register with the club. Yours and your child's data may be shared with selected third parties, suppliers and sub-contractorssuch as referees, coaches or match offciails for the purpose of conducting required activities

Declaration Agreement

The declaration needs to be agreed in order for this registration form to be submitted sucessfully. Please go back and amend.

Registration Form Submitted

The registration form has been submitted successfully.

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