Registration Form

Player Details

Full Name *

D.O.B. *

Address *

Postcode *

Do you know what team you want to join?

Proof of Identity (E.g. passport or birth certificate) *

Choose File

Player Photo (Must be passport style photo) *

Choose File

Additional Details

Player is over 18?

Yes

No

Parent/Guardian Full Name *

Parent/Guardian D.O.B. *

Parent/Guardian Address *

Parent/Guardian Postcode *

Email *

Phone Number

Do you already have a FAN Number? *

Getting Involved *

How Often?

Fees

Annual League Registration Fee: £30.00

Club Membership Fee: £25.00 per month

Payable to Gregson Lane J.F.C.

Account No: 31154699

Sort Code: 40-33-15

The standing order should also include the first 5 letters of the players surname and year of birth.
Once registration documents have been submitted, a standing order should be set up with the above bank details. The monthly standing order of 25.00 per player is payable on the 1st of each month throughout the year.
For example - Harry Thompson 01/02/2007 should be 'THOMP2007'

The club reserves the right to suspend any player from participating in club activities, including all league and cup games, where no monthly membership fee has been paid.

Also please follow us for club updates on our Club Facebook Page:

Facebook

Registration Fee Bank Reference *

Monthly Membership Fee Bank Reference *

Consent Statements

Legal authority to provide consent

Medical Consent

Medical Condition & Any Equipment Required

Agreement

Declaration

"We (The player and Parent/ Guardian) agree to this application being made and certify that the information we have provided in this form is correct. We agree to be bound by the rules and regulations of The Football Association."

"We (The players and Parent/Guardian) also certify that we do not have any outstanding liabilities with any of the above Clubs we
have previously been registered with. We understand that failure to disclose such information or make any false statement will render this registration invalid and liable to sanction"

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