Sign up to St. Anne’s After School Programme (Free School Meal Families ONLY) (full information about this programme can be found HERE) 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. 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 Please confirm you are eligible for FREE SCHOOL MEALS * (you must be part of the government FSM programme, NOT just the universal FSM for rec/yr1/yr2) I agree Thank you for registering for our After School Club session at St Anne’s Primary School. We look forward to seeing you on the pitch soon!
