Wheldrake Juniors Football club

WJFC Player Registration

Please complete all sections to register your child.

Note: To complete the registration, you'll need a passport-type photo of the player. We need a parent's date of birth to comply with FA registrations.

Player Details

First Name

Surname

Date of Birth

School Attended

School Year (as of 01/09)

Age Group (as at 01/09)

Player's passport-type photo

Home Address

Address Line 1

Address Line 2

Town / City

Postcode

Parent / Guardian Details

First Name

Surname

Relationship to Player

Phone Number

Parent's Date of Birth

Alternative Contact (Emergency)

Name

Relationship to Player

Emergency Number

Email (Optional)

Medical Information & Declarations

Known Medical Conditions (if none then write "NONE")

Treatments / Prescriptions

Medical Declaration
I confirm that the treatment for the above condition(s) can be self administered by the player named on this form or that a responsible parent / guardian will be in attendance at all times to take medical responsibility for the player in the event of an incident. I confirm that if the player’s medical status changes I will inform the club and make the necessary arrangements for the management of and administration of treatment whilst attending WJFC. I confirm that this / these condition(s) are controlled in such a way that allows the player to participate in competitive junior football and training sessions.

Safeguarding Declaration
I confirm that the player and parent(s) / guardian(s) agree to abide by the rules of the club and FA Codes of Conduct as applicable to child welfare & safeguarding, including photographic activity in line with England Football Accreditation guidelines celebrating football photographs and video. I recognise that the information given in this form will be used internally within the club to aid administration and may be called upon in the event of an emergency to assist in contact and treatment. I accept that non-payment of the club registration fee, will invalidate the club’s insurance of that player, resulting in a withdrawal of that player from club activities.

Media Declaration

Yes – I agree to the club's privacy notice / data protection policy and accept that players & parents may be included within club approved media material, within the FA Codes of Conduct as applicable to media publication, including photographic activity in line with England Football Accreditation guidelines celebrating football photographs and video.

No – I don't want my child in photos.

Registration Fee

I confirm I will pay for:

Payment Plan

Note: Other payment options are available upon request.

Note: Any issues or questions about payment then please contact your coach.