Sign up to St. Anne’s After School Programme NOW Parent Name * Parent Email * Parent Phone Number * Address * Player Name * Player DOB * School Name Emergency Contact 1 * Please provide NAME/PHONE/RELATIONSHIP TO PLAYER Emergency Contact 2 * Please provide NAME/PHONE/RELATIONSHIP TO PLAYER Player Age Group * Reception Year 1 Year 2 Does the player have any medical conditions/allergies? * Yes No If "yes" above, please give details in the box below Does the player have any recent injuries? Please give details of any recent injuries (acquired either on or off the pitch) including date of injury and any treatment received. Are you registering as part of our "Football Friends" Scheme? If you have been referred by a friend, please give the full PLAYER NAME below and they will receive a free training session! Media Consent * This is to certify that I have no objections to Worksop Town Academy or associated company using any photographic or video images of my child whilst attending a Worksop Town Academy event. Any images will only be used to promote the work of Worksop Town Adacemy/FC to partners and funders along with local, national and social media outlets. I agree I do not agree Parent/guardian consent * We are committed through trained and competent staff to providing a safe learning environment, however football is a contact sport and injuries may occur through no negligence of our staff. We feel it is our responsibility to ensure the safety of the attendee by making sure they come well equipped for the activity i.e. correct footwear, appropriate clothing, food/drinks if appropriate, medication (if applicable). I have read and understood this form, completed all the details requested to the best of my knowledge and will comply with the information set out. I acknowledge and accept that Worksop Town Academy or respective servants shall not have any liability in respect with any loss or damage to property and give permission for my child to receive emergency medical treatment in my absence if deemed necessary. I agree I do not agree Where did you hear about this programme? If you heard about this programme from an Academy coach, please state who in the text box below Previous/other Academy programme Google Facebook/Instagram ads Twitter School flyers Posters Word of mouth/recommended by someone (please give details below) Other (please specify below) Thank you for registering for our After School Clubs. We look forward to seeing you at a training session soon!You will shortly receive an email with more details about the sessions and to issue payment.PLEASE also check your junk/spam inboxes
