Membership Form

Players details

Player's First Name*

Player's Surname*

Player's Date of Birth*

Player's Email*

Player's Mobile Number*



Age Group*

Highest Level Played

School (As of Sept 1st)*

School Year

Next of Kin

We require two different contacts

Father/Guardian 1

Father/Guardian’s Full Name*

Father/Guardian’s Home Telephone*

Father/Guardian’s Mobile*

Father/Guardian’s Home Email*

Father/Guardian’s Work Email

Mother/Guardian 2

Mother/Guardian's Full Name*

Mother/Guardian's Home Telephone*

Mother/Guardian's Mobile*

Mother/Guardian's Home Email*

Mother/Guardian's Work email

Please indicate any medical conditions of which we should be aware (e.g. allergies, asthma etc).


1st Payment date*

(Must be paid within 4 weeks of signing)

2nd Payment date*

(Must be paid within 12 weeks of signing)

If you are paying full amount, please enter same date.


 Medical Consent
In the event of an accident or injury where the coach/administrator is unable to contact either of the contacts named above, then I give permission for the senior age group coach or administrator present to sign the authorisation for any medical treatment or procedure which may be required. I further consent to qualified first aiders to offer first aid treatment if required.

 Data Protection
I acknowledge that I am aware of the purpose for which the data set out above is to be held, used and disclosed by Academy FC and that I consent to the holding, use and disclosure of this data.

 Photo / Video
I consent to the photographing/videoing and publication of images of the above named player under the FA Child Protection and Best Practice Guidelines and I confirm that I am legally entitled to give this consent.

 Terms & Conditions
By Submitting this form you agree to the terms and conditions set out. The season is from 1st of June to the 31st May; on completion of this form please arrange payment via one of the methods listed above.

Read Terms & Conditions

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