Get Kilcock Celtic Football Club Player Registration 2009-2024

Kilcock Celtic Football Club Player Registration Form 2009 / 2010 Address Registration Fee incl Training fee Phone Family Fee 175 Please fill in value of payment Cash GENDER PLEASE CIRCLE MALE Cheque LAST NAME PLEASE PRINT CLEARLY PLAYER Date Rec d FIRST NAME AGE DATE OF BIRTH OFFICIAL USE FEMALE HOME PHONE MAILING ADDRESS MOBILE MAIDEN NAME DAYTIME PHONE LAST NAME MOTHER FATHER NAME CLASS SCHOOL CIRCLE PREVIOUS SOCCER PLAYED BEFORE YES COACH IF KNOWN PLEASE ATTACH THE ORIGINAL BIRTH CERT. IF NOT PREVIOUSLY SUPPLIED PARENT PLEASE CIRCLE ALL APPLICABLE ASSIST TEAM NO NUMBER BIRTH CERT MEDICAL DETAILS CLUB/TEAM WILL VOLUNTEER TO COACH DRIVE OTHER Please indicate if you have any medical conditions we should be aware of e*g* asthma Enter NONE if applicable. REGISTERED SIBLINGS COMMENTS Parental Consent In the event that my son/daughter is injured whilst playing football/travelling to and from football events and I cannot be contacted on the above number I hereby give my consent for my child to receive medical attention* I the parent / guardian recognise that any activity involving motion or contact can create a possibility of injury. I hereby release the Club and its volunteers from claims of any injuries that may be sustained while participating in the program* Parent / Guardian Signature Date required for registration I agree to be bound by and to observe the Club Rules and The Rules and Regulations of the affiliated Leagues and all Competitions in which the Club participates. IF NOT PREVIOUSLY SUPPLIED PARENT PLEASE CIRCLE ALL APPLICABLE ASSIST TEAM NO NUMBER BIRTH CERT MEDICAL DETAILS CLUB/TEAM WILL VOLUNTEER TO COACH DRIVE OTHER Please indicate if you have any medical conditions we should be aware of e*g* asthma Enter NONE if applicable. REGISTERED SIBLINGS COMMENTS Parental Consent In the event that my son/daughter is injured whilst playing football/travelling to and from football events and I cannot be contacted on the above number I hereby give my consent for my child to receive medical attention* I the parent / guardian recognise that any activity involving motion or contact can create a possibility of injury. REGISTERED SIBLINGS COMMENTS Parental Consent In the event that my son/daughter is injured whilst playing football/travelling to and from football events and I cannot be contacted on the above number I hereby give my consent for my child to receive medical attention* I the parent / guardian recognise that any activity involving motion or contact can create a possibility of injury. I hereby release the Club and its volunteers from claims of any injuries that may be sustained while participating in the program* Parent / Guardian Signature Date required for registration I agree to be bound by and to observe the Club Rules and The Rules and Regulations of the affiliated Leagues and all Competitions in which the Club participates. IF NOT PREVIOUSLY SUPPLIED PARENT PLEASE CIRCLE ALL APPLICABLE ASSIST TEAM NO NUMBER BIRTH CERT MEDICAL DETAILS CLUB/TEAM WILL VOLUNTEER TO COACH DRIVE OTHER Please indicate if you have any medical conditions we should be aware of e*g* asthma Enter NONE if applicable. REGISTERED SIBLINGS COMMENTS Parental Consent In the event that my son/daughter is injured whilst playing football/travelling to and from football events and I cannot be contacted on the above number I hereby give my consent for my child to receive medical attention* I the parent / guardian recognise that any activity involving motion or contact can create a possibility of injury. I hereby release the Club and its volunteers from claims of any injuries that may be sustained while participating in the program* Parent / Guardian Signature Date required for registration I agree to be bound by and to observe the Club Rules and The Rules and Regulations of the affiliated Leagues and all Competitions in which the Club participates. .