STAFFORDSHIRE LADSANDADS CLUB

Player Membership Application Form Season 2017/18

If you require any help or assistance please email info@nsjyl.com

Age Group:
Team :
Player Forename(s):
Player Surname:
Player Date of Birth: (click in the box to pop up calender)
Age on 31st August Current Season:
School Attended:
Player Full Address:
Post Code:
Nationality:
Emergency/Parent Contact Number(s):

Parent Email Address(s):

Gender: Male Female
Ethnic Origin:
Details of any disability or known medical conditions:
By ticking the box I agree to abide by the RULES & REGULATIONS laid down by the LADSANDADS Exective & Managemnet Committees at all times. I certify that all the information given on this page is true and correct to best of my knowledge.
I wish to be registered for Season 2017/18 & agree to observe the Rules & Regulations of the League, Staffordshire F.A. Ltd and the Football Association Ltd
Please tick this box if DO NOT want any photography taken

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