Player Registration

Tick Age: Group

Your Full Name (required):  

Date Of Birth:                             (dd/mm/yyyy)


Home Address 1:                      

Home Address 2:                    


Your Email:                               

Parent/Guardian's Name:  

Home Telephone Number:

Mobile Contact (Mum):          

Mobile Contact (Dad):          

Please Provide Medical Information relating to any medication, allergies, dietary requirements that your child may have:

Doctor's Name:                          

Doctor's Address:                      

Doctors'sTelephone Number:

Player Declaration
I confirm that the information I have supplied in this form is correct in every detail. I understand that by submiting this form, I will become officially registered as a player for the team stated in this form, and I am not able to play for any other club in the East London and Essex Youth League, without formally being transferred to another club. I also enclose the appropriate documentation in support of this registration: