PLAYERS DETAILS

Are you Male or Female

First Name/s Surname

Date of birth (e.g. 10/11/90) Age Turning 2004

Have you played for any other clubs in the past two years? Yes No

If yes please give details.

Please enter your home address details below

House Number/Name Street/Road

Town/Area

Zip/Postal code Telephone

E-Mail Address (Parents)

FOR PARENTS/GUARDIANS TO FILL IN

I hereby give permission for my child to sign up for your team/s

First Name/s Surname

Does the child suffer from any allergies or medical conditions?

Yes No

If yes please give details:

If the team requires a coach are you (parent/guardian) willing to help? Yes No

If the team requires a manager are you (parent/guardian) willing to help? Yes No

*PLEASE READ THE FOLLOWING CONDITIONS BEFORE PROCEEDING

In accordance with the Privacy Act

By submitting this form, you are giving the club (Papatoetoe United) permission to use and keep your personal details for the purpose of enrolling your child onto the team roster and the administration of the team as a whole, and for promotional purposes..

If you do not agree with these terms please press the clear button and contact a member of the club committee to discuss other options.

Thank you for filling in this form, we will register your submission and contact you as soon as we can.