Skegness Imps FC Membership Registration Form Season 2015-16 Membership Fees An annual membership of £5 for playing members is payable each year on 1st September. Family Membership for 2 or more players is available at £10* *If applying for family membership please state names of other family members:

Parent / Carer Details First Name: _________________________________ Last Name: _________________________________ Relationship to player: ________________________ Telephone number(s): ________________________

___________________________________________ ___________________________________________ ___________________________________________ **Further match/ league fees may be required upon request

_________________________ _________________________ E-mail: ____________________________________

Postal Address: If different to player’s address

Player’s Details Full Name: _______________________________ Postal Address: ___________________________ _________________________________________ _________________________________________ _________________________________________

__________________________________________ __________________________________________ __________________________________________ __________________________________________ I have read the club’s codes of conduct and agree to follow them. (Copies are available on the club’s website)

Post Code: ________________________________

Signature: _________________________________

Date of Birth: _____________________________

Date:

________________________________

School: ___________________________________ Medical Details Please indicate on the reverse of this sheet if you have any medical conditions we should be aware of, e.g. asthma Medical information given- Yes / No I have read the club’s codes of conduct and agree to follow them. (Copies are available on the club’s website)

Emergency Contact Details In the event that the above named person cannot be reached, please give two extra emergency contact names and numbers: Name: _______________________________________ Relationship to player: ____________________________ Telephone number(s): ___________________________ ___________________________

Signature: ________________________________ Date:

________________________________

Name: _______________________________________ Relationship to player: ____________________________ Telephone number(s): ___________________________ ___________________________