Register – Coxhoe United

Please ensure that you have registered on www.thefa.com prior to completing this form in order to receive your FAN ID. Please also be advised that registration being completed by the club is subject to sufficient space within the appropriate team being available.

Membership of the club is £20.00 per month over 12 months a year and is payable by D/D the first of each month. These cover all running costs for each team.

Coxhoe United Bank Details are sort code – 20-27-41, bank account number – 83872289. Please ensure the payment reference is the name by which your child is referred as.

Players Name *

First

Middle

Last

FAN ID *

Child's Date of Birth

Address *

Post Code *

Contact Phone Number *

Email *

Confirm Email

School Name

School Address

Current School Year *

Please indicate any known medical conditions that we should be aware of (e.g. asthma) *

Emergency Parent/Carer Contact Details *

Emergency Contact Number *

Alternative Emergency Contact Number

Parental/Player Consent *

I accept that Coxhoe United Football Club cannot be held responsible for any accidents that occur during training or games and as such Coxhoe United only have public liability insurance and personnel accident insurance.
In the event that my son/daughter is injured whilst playing football and I cannot be contacted on the numbers provided, I hereby give consent for my child to receive medical attention
I agree to be bound by and observe the Club Rules, Policies, Codes of Conduct and The Rules and Regulations of The Football Association Limited and the Football Association and all competitions in which the club participates.
I consent for my child’s photograph being displayed on the Coxhoe United website and for inclusion in materials for publications in connection with Coxhoe United FC.
I hereby give consent for my son/daughter to be a member and registered player with Coxhoe United Football Club

Print Name

Date