Steeton AFC Players

Fields marked with * are required

Full Name *

Date of Birth *

Place of Birth *

Nationality *

Player's Email *

Contact number *

Home address *

Postcode *

Club Last Registered For *

Other Clubs Registered For This Season

Disclaimer: Are you registered under written contract with another club? *

Yes No

Have You Ever Registered For A Club Outside England? *

Yes No

Are you a goalkeeper? *

Yes No

Has an International Clearance Certificate Been Granted Allowing You To Play In England?

Yes No

Please List All Clubs & Countries Played For Outside of England

Medical & Cultural Consent

Please complete this section to the best of your knowledge

Emergency contact number *

Emergency contact name *

Secondary emergency contact number

Secondary emergency contact name

Next of Kin

Religion and Culture

GP Details *

Photography and Video

At times the Club may wish to take photos or videos of the team or individuals in it. We adhere to The FA Guidelines to ensure these are safe and respectful and used solely for the purposes for which they are intended, which is promotion and celebration of the activities of the Club and for training purposes.

Please indicate if this is acceptable to you

Photography and Video Consent *

Yes No

Health History: Please tick each box that applies (Current or previous)

Accident/ Injury

Car Accident

Whiplash

Fall from height

Head trauma

Skin conditions

Eczema (atopic dermatitis)

Warts/ verruca

Seborrheic Dermatitis (cradle cap)

Any Other Conditions

Surgery

Type of Surgery

Date of Surgery

Any Metal Implants?

Yes No

Details

EU General Data Protection Regulation Consent

I agree to the application being made and certify that the information is correct. I agree to be bound by the rules and regulations of The Football Association and The North West Counties Football League (NWCFL). For the purposes of the Data Protection Act 2018 and the General Data Protection Regulation (GDPR) I acknowledge that The Football Association, NWCFL and Steeton AFC will be collecting, sharing and otherwise processing Personal Data which may include Special Categories of Personal Data (both as defined in the GDPR) about me including such data as set out in this form for the purpose of discharging their functions as a regulatory, administrative and governing bodies of football and otherwise in accordance with The Football Association's Participant Privacy Policy, The NWCFL Privacy Policy and Steeton AFC’s Privacy Policy.

Please Tick to confirm GDPR approval *

Yes

Consent of Player

I give consent for my participation in Steeton AFC Club’s events and agree to the conditions outlined above. I accept that it is my responsibility to inform the Club directly of any changes to the details recorded on this form.

I have read the above information and have stated all my previous medical conditions. I take it upon myself to update Steeton AFC regarding any changes to my health. In the event that am injured whilst playing football whilst representing Steeton AFC, I hereby give my consent to receive medical attention.

I hereby consent for this data to be stored securely on site within Steeton AFC and used at training and matches in case of emergency.

Signed (Please print name ) *

Date: *

Send a copy to your email

Steeton AFC Player Registrations

Open Age Player Registration and Medical Consent Form

Health History: Please tick each box that applies (Current or previous)

Consent of Player