BTFC U7 - U11 Player Registration - Season 2017/18

You will need a squad number and a password to pay and submit form. Thank you BTFC

U7 to U11

Should you have any issues using this form please contact Mike on mike@brackleytownfc.co.uk  please do not contact/email anyone else this will be the your quickest way to get an answer to your problem

Private & Confidential
Personal Details
Players Full Name(*)
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Age Group(*)
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Please enter below the squad number you have been given, if you do not have a squad number please email football@brackleytownfc.co.uk to request one

Squad Number(*)
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Date of birth(*)
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House Number/Name(*)
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Road/Street(*)
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City/Town(*)
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County(*)
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Post Code(*)
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Main Email where all communication will be sent(*)
Please specify your email address.

Education
School/College(*)
Please specify your childs name.

School Number/Name(*)
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Road/Street(*)
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City/Town(*)
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County(*)
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Post Code(*)
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Phone Number(*)
Please specify school landline phone number, no spaces

Do not include spaces

Contact Details

Please provide the details of two people who we can contact if required, one of which must be a parent/guardian.

Primary Contact

Name(*)
Please specify your name

Relationship(*)
Please specify your childs name.

Date of birth(*)
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Date of birth of primary contact is required by the league

Landline Number(*)
Please specify land line phone number, no spaces

Do not include spaces

Mobile Number(*)
Please specify mobile phone number, no spaces

Do not include spaces

Email(*)
Please specify email address.

Other Contact

Name(*)
Please specify your name

Relationship(*)
Please specify your childs name.

Landline Number(*)
Please specify land line phone number, no spaces

Do not include spaces

Mobile Number(*)
Please specify mobile phone number, no spaces

Do not include spaces

Email(*)
Please specify email address.

Medical Details
Doctors Name(*)
Please specify your childs name.

Number/Name(*)
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Road/Street(*)
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City/Town(*)
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County(*)
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Post Code(*)
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Phone Number(*)
Please specify doctors land line number, no spaces

Do not include spaces

Is the player currently taking medication?(*)
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If yes, please provide details of the condition for which the player is taking medication.

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Has the player been in hospital recentley (previous 12 months)?(*)
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If yes, please provide details.

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Has the player ever suffered from any injury which you feel we should know about?(*)
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If yes, please provide details.

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Disclosure

• Player - I agree to abide by the Rules and Codes of Conduct of Brackley Town Football Club, the league, and the FA

(*)
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• Parent/Guardian - I agree to abide by the Rules and Codes of Conduct of Brackley Town Football Club, the league, and the FA

(*)
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• Parent/Guardian - I give my permission for any appropriate medical treatment to be carried out and/or that photos or video may be taken whilst the above named player is taking part in any club or league organised activity.

(*)
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Total to pay

Total to pay
GBP - £0.00

To complete registration you must enter the password you have been given
Password(*)
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Items marked with an * are required.

Once form completed click on 'Confirm and pay for my order' below and you will be taken to 'PayPal' where you can pay through 'PayPal' or by Debit/Credit Card.

You will receive an automated email confirming your purchase

Attached to the confirmation email will be a welcome letter and an invoice for registration fee and subscription

Thank you for your support BTFC

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