The Foundation – Sign On Form – Runcorn Saxons F.C.

Team & Age Group *

Players Name *

First

Last

Players Full Address *

Players Date Of Birth DD/MM/YY *

School Year *

Parent/Guardian Name *

First

Last

Parent / Guardian Date Of Birth DD/MM/YY *

Parent / Guardian FAN Number (FA No. if known)

Emergency Contact Number 1 *

Emergency Contact Number 2 *

Parent/Guardian Email *

Any Medical History That We Should Be Aware Of? *

Any Allergies? If YES please state *

Yes - please state below
No

Allergies

Does The Player Suffer From Diabetes? *

Yes
No

Any History Of Heart Disease In The Family, Parents & Grandparents? *

Yes - If yes please state below
No

Family Members With Previous Heart Disease? i.e. Mother

Does The Player Suffer From Epilepsy? *

Yes
No

Does The Player Suffer From Asthma Or Any Other Related Breathing Problems? *

Yes - If yes you need to provide your coach with an inhaler labelled with your childs name
No

Is The Player Taking Any Medication? *

Yes - If yes please state below
No

The Player Is Taking The Following Medication

Are There Any Other Medical Or Physical Conditions That We Need To Be Aware Of? *

Yes - If yes please state below
No

Medical or Physical Conditions

Do Runcorn Saxons FC Have Consent To Send The Player To Hospital If Required? *

Yes
No

I consent for the players photo to be used for Club PR and shared on social media. *

Yes
No

If you answered No, please give reason.

By Submitting This Form You Are Granting Parental Agreement For Your Child To Participate In RSFC's 'The Foundation' Football Sessions and Related Small Sided Game Activities. *

Please Type YES In The Above Box And Submit The Form.

The Foundation – Sign On Form

Please complete and submit the medical registration form below.

The Foundation Player Sign On Form