Player Registration Form

Once submitted, this form will be sent directly to the Chairman, Dave Johnson. A confirmation message will appear on screen for approximately 8 seconds.

You are not expected to answer every question. The form is designed for people wishing to join the club for social reasons as well as for those with previous football or walking football experience.

You may choose which Health & Medical Information you wish to share. Any information provided will be treated as strictly confidential and used only to help ensure player safety.

You can press "tab" on your keyboard to progress to the next field.

First name

Last name

Date of Birth

Address

Post code

Mobile phone

Primary Emergency Contact Name

Relationship to Player

Secondary Contact (optional)

Primary Playing Position(s)

Preferred Foot

Standard Historically Played At (e.g., grassroots, district, county, semipro, professional)

Previous Clubs (with years)

Notable Trophies / Achievements

Have you signed for any other Club to play in league matches? Which club and what age groups?

Existing Medical Conditions

Allergies

Current Medication

Any injuries in the last 12 Months

GP Name & Practice (optional)

First Aid Training / Certification

Level / Type

Expiry Date

Coaching or Managerial Experience:

Qualifications (if any)

Clubs / Teams Managed or Coached

Reason for Wanting to Join the Club

Availability for Training & Matches

Willingness to Assist with Club Activities (optional): (e.g., coaching, admin, matchday support)

I confirm that the information provided is accurate (type name)

Date

I consent to the Club holding my data for registration and safety purposes (type name)

Date