Registration

PLAYERS REGISTRATION FORM 2011/ 2012 SEASON

PLAYERS FULL NAME ...........................................................................................................

FULL ADDRESS  .....................................................................................................................

DATE OF BIRTH ........./........../.......... Tel:  Home.. ...............................Mob:....................................…

E-mail…………………………………………………………………………………………………..

SCHOOL ...................................................................  FORM / CLASS .................................

PARENT / GUARDIAN NAME ...............................................................................................

This form complete in all respects must be returned to the team manager, along with

1) A copy of the player’s birth certificate or medical card  (originals will not be accepted)

2) The attached Insurance Liability Waiver Form fully completed  and signed.

3) The attached Medical Form (not compulsory, but recommended) fully completed and signed.

4) Two most recent Passport Size Photographs.( Junior teams only)

5) A Registration fee of £25. This can be paid in two instalments first £15.00 due before 29^th July 2011 and remaining £10.00 to be paid by 28^th December 2011  (Cheques made payable to Blackburn United)

You will not be eligible to play for Blackburn United FC until payment has been made.

By completing the signatures below you are agreeing to abide by the team and club rules issued by Blackburn United, and accept the disciplinary actions outlined in the rules.

PLAYERS SIGNATURE …………………………………………….                Date  ……/……. /……….

PARENT / GUARDIAN SIGNATURE …………………………………………….Date….. /……../………..

.............................................DO NOT WRITE BELOW, FOR CLUB USE ONLY.............................................

Proof of date of Birth     .................................................................       Passport Photographs ..............

Registration fee      ......................................................................         Medical Form  ........................

CLUB ID NUMBER ...........................      LEAGUE REGISTRATION NUMBER  .............................................