Summer Football

Player's Name *

First

Last

Player's Date of Birth *

E.g. 01/01/2016

Parent/Guardian's Name *

First

Last

Parent/Guardian's Contact Number *

If there is an emergency we will try and reach you on this number.

Parent/Guardian's email address *

Any medical conditions or allergies we should be aware of *

E.g. asthma

Home Address *

Booking (NB spaces are limited to 20 children for each session)

I would like to book my child in for all 8 sessions. I will bring £15 cash to the first session s/he attends. I understand that late arrival to any session may mean the place is given to another child.
I would like my child to attend occasionally. I will bring £2 cash to each session. I understand that priority will be given to children booked in for all 8 sessions.

How did you hear about these sessions? *

As parent/guardian, I give permission for my child named on this form to take part in these football sessions. I understand that while attending, my child will be under the care and supervision of the coach and volunteer helpers. Ambassadors Football (AF) and St Andrew's Livesey church are under no liability for loss or damage to personal property. Every effort will be made to contact me should my child become ill or have an accident. I give permission for medical treatment in the event of illness or accident if I cannot be contacted, and in the case of an emergency. *

should as children

How will your child get home? *

An adult will collect them (enter name below)
I give permission for them to walk home alone

If an adult will be collecting your child, enter their name(s) here

Ambassadors Football (AF) and St Andrew's Livesey church may take photos or videos of the activities as a record and to celebrate the event. May we use your child's image in photos and videos for various media produced? Your child's name will not be used. *

Yes, I give permission
No, I do not give permission

I understand that this information is being collected to enable the safe and smooth running of the football sessions. St. Andrew's Livesey would also like to contact you occasionally with news of upcoming events for children and young people. Are you happy for your contact details to be stored and used for this purpose? *

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