Please enable JavaScript in your browser to complete this form.Age Group *U6U7U8U9U11U12U13U13 UnitedU14U15U15 UnitedU16U18Select the Age Group being played in, during 2022-23Name *FirstLastHome Telephone NumberMobile Telephone NumberEmail *Players Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Alternative Emergency Contact Name *FirstLastEmergency Contact Number *Does the Player have any Medical Conditions *YesNoMedical Conditionsplease specify any existing medical conditions that may be relevant and medication being taken You must also discuss any medical condition with the team managerSocial Media / Website Photo Permission *I agree to my son’s/daughter’s picture being shown on the website/ FacebookI do not agree to my son’s/daughter’s picture being shown on the website / Facebook.During the course of the season we may put pictures onto the Storrington Swans website https://storringtoncfc.co.uk and private Facebook page. Please tick one of the above boxes:Social Media / Website Video Permission *I agree to my son’s/daughter’s video being shown on the website/ FacebookI do not agree to my son’s/daughter’s video being shown on the website / Facebook.During the course of the season we may video your child for training purposes and put the video on the private Facebook page. Please tick one of the above boxes:Has the Player played or registered with a club outside of England *YesNoIf Yes, Has the Player obtained International Clearance from the FAYesNoCode of Conduct - Confirmation *I ConfirmI Confirm that the player, parents and guardians have read and accepted the Code of Conduct - https://storringtoncfc.co.uk/code-of-conduct/Information Consent - Confirmation *I ConfirmI certify that the above information is correct and give consent to the information I have provided on this form being used by the Club for any purposes under the General Data Protection Regulations (GDPR) 2018. I also certify that I do not have any outstanding liabilities with any of the clubs I / my son / my daughter have been previously registered with. I understand that failure to disclose such information or make any false statements will render the registration invalid and liable to sanction. I confirm that I permit my son/daughter to take part in football activities organised by Storrington Community F.C on the understanding that the club is not liable should he/she receive an injury.Please Upload a Photo of the Player Click or drag a file to this area to upload. A Photo is required for the League registration. Photo requirements are as follows:- - Of the Players Head and Shoulders - Forward Facing - Alone and not part of a group - A current, reasonable likeness of the player - Avoid other people in the background of the photoFAN NumberIf the player has not been registered to a league by Storrington CFC before and they already have a FAN Number, please provide it hereRegistration Fee *Pay by Lump Sum by 31st July 2022 - £120.00Will discuss with ClubThe Registration fee is £120.00 as a lump sum payment to be paid prior to 31st July 2022. If you would like to discuss alternative payment options please email lizstorringtonswans@outlook.com Payment details are as follows: Payment can be made by Cheque or BACS. Please make cheques payable to Storrington Community FC and hand to your Team Coach. If paying by BACS: account number: 54534862, sort code: 30-98-97 Please add Child name and Age Group to Payment Description. PLEASE NOTE NEW BANK DETAILS THAT ALL PAYMENTS MUST BE PAID INTO Signed Player *FirstLastBy Inserting your name you are signing confirmationSigned Parent / Guardian *FirstLastBy Inserting your name you are signing confirmationDate Signed *Submit